Diagnostic studies of hypertrophic cardiomyopathy

(EHJ 2014;35:2733)

• ECG: LVH, anterolateral TWI and inferior pseudo-Qw, ± apical giant TWI (apical variant)
• Echo: any LV wall segment ≥15 mm (or ? even ≥13 if ⊕ HFx), often but not necessarily involving septum; other findings include dynamic outflow obstruction, SAM, MR
• MRI: hypertrophy + patchy delayed enhancement (useful for dx & prog) (Circ 2015;132:292)
• Cardiac cath: subaortic pressure ∇; Brockenbrough sign = ↓ pulse pressure post-PVC (in contrast to AS, in which pulse pressure ↑ post-PVC); spike & dome Ao pressure pattern
• Consider genotyping for family screening; pathogenic variant ID’d in <½ (Circ 2020;142:e558)