13 Myocardial Pathology
Hypertrophic Cardiomyopathy
Background

Figure 13-1 Parasternal long axis and short axis two-dimensional images of a patient with classic reverse curvature hypertrophic cardiomyopathy (HCM) and primary involvement of the basal anterior septum. Measurement of maximal wall thickness is performed at the greatest diameter, excluding right ventricular band insertion.

Figure 13-2 Apical four-chamber (4C) view of a patient with mid-ventricular HCM demonstrating mid-ventricular and papillary muscle hypertrophy and secondary apical aneurysm formation due to midventricular obstruction.

Figure 13-3 Apical 4C echocardiographic (left) and cardiac magnetic resonance imaging (MRI) (right) views of a patient with apical HCM. Cardiac MRI can provide a good depiction of apical thickness and function when echocardiographic imaging is inadequate.
TABLE 13-1 FEATURES DISTINGUISHING “ATHLETE’S HEART” FROM HCM IN ADULTS*
Feature | Athlete’s Heart | HCM |
---|---|---|
Maximal wall thickness | ≤16 mm | ≥13 mm |
Pattern of LVH | Predominantly concentric | Concentric or asymmetrical |
LV cavity dimension | Often > 55 mm (in endurance athletes) | Usually < 45 mm |
Diastolic function | Normal | Normal or abnormal |
Gender | Male > female | Male = female |
Family history of HCM or SCD | No | Yes or no |
Delayed enhancement (MRI) | No | Yes or no |
Exercise capacity | Above normal | Normal to below normal |
Response to deconditioning | LVH regression | No change in LVH |
* Intended for adults or adult-sized teenagers. Corresponding Z scores can be calculated for children but have not been validated.
Echocardiographic Approach (Table 13-2)
Anatomic Imaging

Figure 13-4 Apical long axis view of a patient with outflow tract obstruction due to systolic anterior motion of the mitral valve (MV) leaflets.
Physiologic Data

Figure 13-6 Complete LVOTO may result in a “lobster claw” appearance of the pulsed wave (PW) Doppler (A); more commonly, a characteristic dagger-shaped, late-peaking continuous wave (CW) Doppler signal is seen (B).
Alternate Approaches
Dilated Cardiomyopathy

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