Hypertrophic Cardiomyopathy

Abstract

ypertrophic cardiomyopathy (HCM) is a fascinatingdisease that has intrigued and challenged cardiolo-gists for decades. Initially a diagnosis made bymaster clinicians adept at translating bedside dynamic aus-cultation into hemodynamic pathophysiology, HCM contin-ues to challenge the frontiers of diagnosis and technology.The development of 2D and Doppler echocardiography pro-vided the greatest increment in understanding the complexityof HCM. While clinicians at large became skilled at thebedside detection of dynamic left ventricular outflow obstruc-tion, echocardiography revealed that many more patients hadunexplained left ventricular hypertrophy (LVH) consistentwith HCM but without evidence of obstruction. In fact, thenonobstructive, “silent” forms are more frequent than theobstructive, “noisy” variants. The pattern and severity ofLVH are now appreciated as heterogeneous and diastolicdysfunction as highly prevalent.