Hypertrophic Cardiomyopathy

Episode overview

Hypertrophic cardiomyopathy is an inherited myocardial disease characterized by unexplained left ventricular hypertrophy, impaired diastolic filling, and sometimes dynamic left ventricular outflow tract obstruction. In this episode, Chris and Mars review the classic genetics and asymmetric septal hypertrophy of HCM, systolic anterior motion of the mitral valve, why the murmur gets louder with standing and Valsalva, exertional dyspnea, angina, syncope, and sudden cardiac death, echocardiography and cardiac MRI findings, beta blockers as first-line treatment for symptomatic obstructive HCM, medications and volume changes that can worsen outflow obstruction, sudden-death risk assessment and implantable cardioverter-defibrillator indications, and atrial fibrillation, anticoagulation, exercise, genetics, and family screening. Episode pearl: In obstructive HCM, a smaller left ventricular cavity means more obstruction—which explains both the murmur maneuvers and many of the treatment decisions.