Hypertrophic cardiomyopathy

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Hypertrophic cardiomyopahty (HCM, HOCM) is a myocardial disease resulting in marked hypertrophy of the ventricle due to genetic abnormalities. HCM can be a cause of sudden cardiac death. Assessment by echocardiography is very important in diagnosis, assessing prognosis and follow up.

Contents

Classification

  • type I - septal anterior hypertrophy
  • type II - septal anterior and septal posterior hypertrophy
  • type III - septal and antero-lateral hypertrophy
  • type IV - antero-lateral and/or septal posterior hypertrophy
  • type V - concentric hypertrophy
  • type VI - apical hypertrophy

Echocardiographic assessment

2D echocardiography

  • Left ventricular hypertrophy - usually asymmetric hypertrophy involving the interventricular septum.
  • Report wall thickness, ratio of septal to posterior wall thickness and left ventricular mass.
  • The hypertrophied septum can almost obliterate the cavity.
  • Left atrium is usually enlarged due to the elevated ventricular pressure.

M-mode

  • Aortic valve leaflet flutter during closure
  • Systolic anterior motion of mitral valve

Doppler echocardiography

  • Colour flow mapping shows turbulence at the left ventricular outflow tract.
  • Continuous wave Doppler through the outflow tract in the apical 5 chamber view shows presence of LVOT gradient if any.
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