Hypertrophic Cardiomyopathy (HCM)

This infographic provides a structured overview of Hypertrophic Cardiomyopathy (HCM), focusing on its diagnosis, clinical presentation, and management strategies.

• Diagnosis
• Wall thickness ≥15 mm detected via TTE, CT, or MRI.
• HCM is confirmed by ruling out secondary causes of LVH such as hypertension or myocardial infiltration. Genetic testing and MRI findings (e.g., LGE) support diagnosis.
• LVOT Assessment and Obstruction
• Resting gradient >50 mmHg confirms obstruction; for borderline cases (<50 mmHg), obstruction is provoked via:
  • Valsalva maneuver
  • Amyl nitrate administration
  • Stress testing
  • Cardiac catheterization
• Clinical Presentation and Physical Exam
• Symptoms: Dyspnea, angina, syncope, and palpitations.
• Physical findings include a holosystolic murmur, which intensifies with Valsalva or standing, and pulsus bisferiens.
• Diagnostic Findings
• Echo Findings:
  • Asymmetric septal thickening, SAM (systolic anterior motion of the mitral valve), and posterior jet MR.
• EKG Findings:
  • Repolarization abnormalities, LVH, and ST-T wave changes (e.g., apical HCM presenting with deep T-wave inversion).
• Management Strategies
• Prevent Symptoms
  • Medical therapy: Beta-blockers (BB), calcium channel blockers (CCB), disopyramide.
  • Avoid diuretics, vasodilators, and digoxin.
  • Drug-refractory cases: Surgical myectomy, alcohol septal ablation, or heart transplant.
  • Lifestyle changes: Avoid alcohol, stimulants, dehydration, and temperature extremes.
• Prevent Stroke
  • Atrial fibrillation requires anticoagulation, regardless of CHADSVASc score.
• Prevent Sudden Cardiac Death (SCD)
  • Genetic screening for all first-degree relatives.
  • Risk factors: Family history of SCD, unexplained syncope, septum ≥3 cm, NSVT (nonsustained VT), or abnormal BP response.

This infographic provides a comprehensive framework for managing HCM by preventing symptoms, stroke, and sudden cardiac death.

Produced by Dr. Carine Hamo
“4 P’s of Prevention” by Dr. Amit Goyal

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