eMedicine Specialties > Radiology > Cardiac

Cardiomyopathy, Hypertrophic: Follow-up

Author: Diwaker Agarwal, MD, Staff Physician, Department of Radiology, Mercy Medical Center
Coauthor(s): George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center
Contributor Information and Disclosures

Updated: Apr 7, 2009

Intervention

The management of hypertrophic cardiomyopathy (HCM) involves identifying and reducing the risk of sudden death and providing medical and/or invasive treatments for the purpose of alleviating symptoms and preventing complications. Family members of patients should undergo echocardiographic screening to facilitate early diagnosis and management.

Determining risk for sudden death

HCM patients should undergo periodic evaluation for risk stratification. These assessments should include the following2 :

  • Personal and family history
  • Two-dimensional echocardiography
  • 24- or 48-hour ambulatory ECG monitoring for ventricular tachycardia
  • Treadmill or bicycle exercise testing for measurement of blood pressure response.

Electrophysiologic studies are not part of the routine evaluation of HCM patients, but they may be considered in selected cases, such as in patients with otherwise unexplained syncope.

Although the presence of a single marker indicating sufficiently high risk may justify placement of an implantable cardioverter-defibrillator (ICD),72 individual risk factors generally have low accuracy for predicting sudden cardiac death in HCM. Consequently, risk factor profiles are often used. Important risk factors include the following21 :

  • Prior history of cardiac arrest
  • History of recurrent syncope and family history of sudden cardiac death
  • Severe LVH (maximum wall thickness > 30 mm); positive predictive accuracy for sudden cardiac death 13%, negative predictive accuracy 95%
  • LVOT (gradient >30 mm Hg); positive predictive accuracy 7%, negative predictive accuracy 95%
  • Stable or decreasing blood pressure in response to exercise; positive predictive accuracy in adults 15%, negative predictive accuracy 97%
  • Nonsustained ventricular tachycardia during ambulatory ECG monitoring; in adults, positive predictive accuracy 25%, negative predictive accuracy 85%


Implantable cardioverter-defibrillators

In high-risk HCM patients, ICDs have proved effective and reliable in preventing sudden cardiac death.2 An international study of over 500 patients found that the ICDs aborted ventricular tachycardia or fibrillation in 20% of patients; of interventions in patients who received an ICD for primary prevention, 35% were in patients who had undergone implantation for a single risk factor.72

Medical treatment

Pharmacologic therapy is aimed at improving LV diastolic filling, decreasing LVOT obstruction, decreasing myocardial ischemia, and maintaining a sinus rhythm. It should alleviate or reduce the patient's symptoms and improve his or her exercise tolerance.

In patients with LVOT obstruction, beta blockers are the mainstay of medical therapy; disopyramide may be used in combination with beta blockers. In patients with nonobstructive HCM, beta blockers, verapamil, and diltiazem can be used.73  No evidence suggests that the use of beta blockers and verapamil together is more beneficial than the use of either agent alone. Unfortunately, the use of these agents does not prevent sudden death or prolong survival. Verapamil should be used cautiously in patients with marked outflow gradients or elevated pulmonary pressure because its vasodilator effects can result in serious hemodynamic complications. Treatment of end-stage HCM is with diuretics, vasodilators, and digitalis.7

Amiodarone can be used in the treatment of both atrial and ventricular arrhythmias. It can provide symptomatic relief, but it has not been shown to prevent sudden cardiac death; ICDs should be used for that purpose. Adverse effects include conduction abnormalities in about 20% of patients. Amiodarone has an American College of Cardiology/American Heart Association/European Society of Cardiology class IIa recommendation (evidence level C) for prevention of recurrent atrial fibrillation in HCM patients.74 It should be used only in symptomatic patients and with electrophysiologic guidance.23

Prophylaxis against infective endocarditis is recommended in HCM with latent or resting LV outflow obstruction or intrinsic mitral valve disease.2 Arterial or venous vasodilators may precipitate and aggravate the obstruction and cause hypotension and syncope. Thus, angiotensin-converting enzyme inhibitors and nitrates should be avoided.75

Invasive treatment

Invasive treatments are reserved for patients who have severe refractory symptoms despite medical treatment, usually those with outflow tract gradients of 50 mm Hg or more. Approximately 5% of HCM patients overall are candidates for such treatment.2 Surgical resection of the hypertrophied IVS (ventricular septal myotomy-myectomy) is the established procedure. The surgical mortality is 2% or less, but the operation should be limited to experienced centers.35  Myectomy has an initial success rate of 90% in decreasing symptoms and LV outflow obstruction, and about 70% of patients maintain improved symptoms and exercise performance for 5 years or longer.2,7 Complications include left bundle branch block, ventricular septal defect, atrioventricular conduction block, arrhythmias, and aortic regurgitation. Also, the mitral valve with a low-profile prosthetic valve can be replaced to relieve the obstruction.

Dual-chamber pacing has been proposed as a method for decreasing symptoms and improving the hemodynamics in LV outflow obstruction; however, randomized crossover clinical trials have shown little objective evidence of improved exercise capacity.7 Pacing is therefore not a primary treatment for HCM, but may be worth considering in selected patients, such as elderly patients of advanced age who are poor surgical candidates.2

Alcohol septal ablation has gained popularity as a treatment for LV outflow obstruction and intractable symptoms refractory to medical or other invasive methods. In this procedure, a small amount of absolute alcohol is injected into the septal branch of the left anterior descending artery supplying the hypertrophied portion of the IVS. This causes a controlled myocardial infarction, reducing obstruction and improving symptoms.

In properly selected patients, alcohol septal ablation can produce rapid and dramatic clinical improvement, with morbidity, mortality, and complication rates comparable to those of septal myectomy.2 Ablation is easier to perform than myectomy, with no sternotomy required, and involves less discomfort and a shorter hospital stay and recovery period; consequently, alcohol ablation has become much more widely used than septal myectomy.2 . Nevertheless, because of concerns over potential long-term risk for arrhythmias generated by intramyocardial scarring from alcohol ablation, as well as evidence of superior exercise testing results with surgery, septal myectomy remains the gold standard for severely symptomatic HCM patients who have marked LVOT obstruction that is refractory to maximal medical management.2,7

For HCM patients with refractory heart failure, heart transplantation may be the only therapeutic option. Long-term outcome in HCM patients who undergo heart transplantation is comparable to that in patients who undergo transplantation for idiopathic dilated cardiomyopathy.76

Medicolegal Pitfalls

Physicians participating in medical evaluations of competitive athletes face potential medicolegal pitfalls, especially in view of the overlap between athlete’s heart and hypertrophic cardiomyopathy.77 The American Heart Association (AHA) has published recommendations on preparticipation cardiovascular screening of competitive athletes.78 Physicians screening competitive athletes should adhere strictly to these recommendations.77

The 36th Bethesda Conference, sponsored by the American College of Cardiology, offered recommendations for monitoring athletes with preclinical HCM, as well as recommending that "Athletes with a probable or unequivocal clinical diagnosis of HCM should be excluded from most competitive sports, with the possible exception of those of low intensity.”79

 


More on Cardiomyopathy, Hypertrophic

Overview: Cardiomyopathy, Hypertrophic
Imaging: Cardiomyopathy, Hypertrophic
Follow-up: Cardiomyopathy, Hypertrophic
Multimedia: Cardiomyopathy, Hypertrophic
References
Further Reading
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References

  1. Maron, BJ. Hypertrophic Cardiomyopathy. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: WB Saunders; 2007:Chapter 65.

  2. Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. Nov 5 2003;42(9):1687-713. [Medline]. [Full Text].

  3. Alcalai R, Seidman JG, Seidman CE. Genetic basis of hypertrophic cardiomyopathy: from bench to the clinics. J Cardiovasc Electrophysiol. Jan 2008;19(1):104-10. [Medline].

  4. Maron BJ, Roberts WC. Quantitative analysis of cardiac muscle cell disorganization in the ventricular septum of patients with hypertrophic cardiomyopathy. Circulation. Apr 1979;59(4):689-706. [Medline].

  5. Maron BJ, Bonow RO, Cannon RO 3rd. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy (1). N Engl J Med. Mar 26 1987;316(13):780-9. [Medline].

  6. Becker AE. The cardiomyopathies revisited from jungle to jumble. In: Crijns HJ, Kingma JH, Viersma JW, eds. Heart Failure: From Conduction to Contraction. Dordecht, the Netherlands: Kluwer Academic Publishers;1994: 117-30.

  7. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. Mar 13 2002;287(10):1308-20. [Medline]. [Full Text].

  8. Maron BJ, Pelliccia A, Spirito P. Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete's heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation. Mar 1 1995;91(5):1596-601. [Medline].

  9. Maron BJ, Pelliccia A, Spataro A, Granata M. Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J. Feb 1993;69(2):125-8. [Medline].

  10. Lewis JF, Maron BJ. Hypertrophic cardiomyopathy characterized by marked hypertrophy of the posterior left ventricular free wall: significance and clinical implications. J Am Coll Cardiol. Aug 1991;18(2):421-8. [Medline].

  11. Shapiro LM. Hypertrophic cardiomyopathy in the elderly. Br Heart J. May 1990;63(5):265-6. [Medline].

  12. Karam R, Lever HM, Healy BP. Hypertensive hypertrophic cardiomyopathy or hypertrophic cardiomyopathy with hypertension? A study of 78 patients. J Am Coll Cardiol. Mar 1 1989;13(3):580-4. [Medline].

  13. Spirito P, Autore C. Management of hypertrophic cardiomyopathy. BMJ. May 27 2006;332(7552):1251-5. [Medline]. [Full Text].

  14. Kibira S, Miura M. Epidemiology of dilated cardiomyopathy and hypertrophic cardiomyopathy. Nippon Rinsho. Jan 2000;58(1):141-6. [Medline].

  15. Ho HH, Lee KL, Lau CP, Tse HF. Clinical characteristics of and long-term outcome in Chinese patients with hypertrophic cardiomyopathy. Am J Med. Jan 1 2004;116(1):19-23. [Medline].

  16. Hada Y, Sakamoto T, Amano K. Prevalence of hypertrophic cardiomyopathy in a population of adult Japanese workers as detected by echocardiographic screening. Am J Cardiol. Jan 1 1987;59(1):183-4. [Medline].

  17. Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation. Nov 20 2001;104(21):2517-24. [Medline]. [Full Text].

  18. McKenna WJ. The natural history of hypertrophic cardiomyopathy. Cardiovasc Clin. 1988;19(1):135-48. [Medline].

  19. Harris KM, Spirito P, Maron MS, Zenovich AG, Formisano F, Lesser JR, et al. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation. Jul 18 2006;114(3):216-25. [Medline]. [Full Text].

  20. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. Apr 11 2006;113(14):1807-16. [Medline]. [Full Text].

  21. Frenneaux MP. Assessing the risk of sudden cardiac death in a patient with hypertrophic cardiomyopathy. Heart. May 2004;90(5):570-5. [Medline]. [Full Text].

  22. Clark AL, Coats AJ. Screening for hypertrophic cardiomyopathy. BMJ. Feb 13 1993;306(6875):409-10. [Medline].

  23. Fananapazir L, McAreavey D. Hypertrophic cardiomyopathy: evaluation and treatment of patients at high risk for sudden death. Pacing Clin Electrophysiol. Feb 1997;20(2 Pt 2):478-501. [Medline].

  24. Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. Sep 1993;22(3):796-804. [Medline].

  25. Botvinick EH, Dae MW, Krishnan R, Ewing S. Hypertrophic cardiomyopathy in the young: another form of ischemic cardiomyopathy?. J Am Coll Cardiol. Sep 1993;22(3):805-7. [Medline].

  26. Maron BJ, Carney KP, Lever HM, Lewis JF, Barac I, Casey SA, et al. Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol. Mar 19 2003;41(6):974-80. [Medline].

  27. Olivotto I, Maron MS, Adabag AS, Casey SA, Vargiu D, Link MS, et al. Gender-related differences in the clinical presentation and outcome of hypertrophic cardiomyopathy. J Am Coll Cardiol. Aug 2 2005;46(3):480-7. [Medline].

  28. Schulz-Menger J, Abdel-Aty H, Rudolph A, Elgeti T, Messroghli D, Utz W, et al. Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: insights from cardiovascular magnetic resonance. Eur J Heart Fail. Sep 2008;10(9):850-4. [Medline].

  29. Wayne J, Braunwald E. Cardiomyopathy and Myocarditis. In: Fauci AS, Braunwald E, Kasper DL, et al. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw-Hill; 2008:Chapter 231.

  30. Kar AK, Roy S, Panja M. Aortic regurgitation in hypertrophic cardiomyopathy. J Assoc Physicians India. Sep 1993;41(9):576-8. [Medline].

  31. McKenna WJ, Spirito P, Desnos M, Dubourg O, Komajda M. Experience from clinical genetics in hypertrophic cardiomyopathy: proposal for new diagnostic criteria in adult members of affected families. Heart. Feb 1997;77(2):130-2. [Medline]. [Full Text].

  32. Bicudo LS, Tsutsui JM, Shiozaki A, Rochitte CE, Arteaga E, Mady C, et al. Value of real time three-dimensional echocardiography in patients with hypertrophic cardiomyopathy: comparison with two-dimensional echocardiography and magnetic resonance imaging. Echocardiography. Aug 2008;25(7):717-26. [Medline].

  33. Caselli S, Pelliccia A, Maron M, Santini D, Puccio D, Marcantonio A, et al. Differentiation of hypertrophic cardiomyopathy from other forms of left ventricular hypertrophy by means of three-dimensional echocardiography. Am J Cardiol. Sep 1 2008;102(5):616-20. [Medline].

  34. Ennis DB, Epstein FH, Kellman P, Fananapazir L, McVeigh ER, Arai AE. Assessment of regional systolic and diastolic dysfunction in familial hypertrophic cardiomyopathy using MR tagging. Magn Reson Med. Sep 2003;50(3):638-42. [Medline]. [Full Text].

  35. Aurigemma G, Reichek N, Schiebler M. Evaluation of mitral regurgitation by cine magnetic resonance imaging. Am J Cardiol. Sep 1 1990;66(5):621-5. [Medline].

  36. Sardanelli F, Quarenghi M. MR spectroscopy of the heart. Radiol Med. Dec 2006;111(8):1025-34. [Medline].

  37. Hansen MW, Merchant N. MRI of hypertrophic cardiomyopathy: part I, MRI appearances. AJR Am J Roentgenol. Dec 2007;189(6):1335-43. [Medline]. [Full Text].

  38. Yoshida M, Takamoto T. Left ventricular hypertrophic patterns and wall motion dynamics in hypertrophic cardiomyopathy: an electron beam computed tomographic study. Intern Med. Apr 1997;36(4):263-9. [Medline].

  39. Naito H, Saito H, Ohta M. Significance of ultrafast computed tomography in cardiac imaging: usefulness in assessment of myocardial characteristics and cardiac function. Jpn Circ J. Mar 1990;54(3):322-7. [Medline].

  40. Saito H, Naito H, Takamiya M. Late enhancement of the left ventricular wall in hypertrophic cardiomyopathy by ultrafast computed tomography: a comparison with regional myocardial thickening. Br J Radiol. Nov 1991;64(767):993-1000. [Medline].

  41. Park JH, Kim YM, Chung JW. MR imaging of hypertrophic cardiomyopathy. Radiology. Nov 1992;185(2):441-6. [Medline].

  42. Sardanelli F, Molinari G, Petillo A. MRI in hypertrophic cardiomyopathy: a morphofunctional study. J Comput Assist Tomogr. Nov-Dec 1993;17(6):862-72. [Medline].

  43. Posma JL, Blanksma PK, van der Wall EE. Assessment of quantitative hypertrophy scores in hypertrophic cardiomyopathy: magnetic resonance imaging versus echocardiography. Am Heart J. Nov 1996;132(5):1020-7. [Medline].

  44. Maron MS, Hauser TH, Dubrow E, Horst TA, Kissinger KV, Udelson JE, et al. Right ventricular involvement in hypertrophic cardiomyopathy. Am J Cardiol. Oct 15 2007;100(8):1293-8. [Medline].

  45. de Roos A, Doornbos J, Luyten PR, Oosterwaal LJ, van der Wall EE, den Hollander JA. Cardiac metabolism in patients with dilated and hypertrophic cardiomyopathy: assessment with proton-decoupled P-31 MR spectroscopy. J Magn Reson Imaging. Nov-Dec 1992;2(6):711-9. [Medline].

  46. Mirowitz SA, Lee JK, Gutierrez FR. Normal signal-void patterns in cardiac cine MR images. Radiology. Jul 1990;176(1):49-55. [Medline].

  47. Utz JA, Herfkens RJ, Heinsimer JA. Valvular regurgitation: dynamic MR imaging. Radiology. Jul 1988;168(1):91-4. [Medline].

  48. Wagner S, Auffermann W, Buser P. Diagnostic accuracy and estimation of the severity of valvular regurgitation from the signal void on cine magnetic resonance images. Am Heart J. Oct 1989;118(4):760-7. [Medline].

  49. Fattori R, Rapezzi C, Castriota F. Clinical significance of magnetic resonance and echocardiographic correlations in the evaluation of hypertrophic cardiomyopathy. Radiol Med (Torino). Jul-Aug 1994;88(1-2):36-43. [Medline].

  50. O'Hanlon R, Assomull RG, Prasad SK. Use of cardiovascular magnetic resonance for diagnosis and management in hypertrophic cardiomyopathy. Curr Cardiol Rep. Mar 2007;9(1):51-6. [Medline].

  51. Moon JC, McKenna WJ, McCrohon JA, Elliott PM, Smith GC, Pennell DJ. Toward clinical risk assessment in hypertrophic cardiomyopathy with gadolinium cardiovascular magnetic resonance. J Am Coll Cardiol. May 7 2003;41(9):1561-7. [Medline].

  52. Hansen MW, Merchant N. MRI of hypertrophic cardiomyopathy: part 2, Differential diagnosis, risk stratification, and posttreatment MRI appearances. AJR Am J Roentgenol. Dec 2007;189(6):1344-52. [Medline]. [Full Text].

  53. Fattori R, Rocchi G, Celletti F, et al. Contribution of magnetic resonance imaging in the differential diagnosis of cardiac amyloidosis and symmetric hypertrophic cardiomyopathy. Am Heart J. Nov 1998;136(5):824-30. [Medline].

  54. Jung WI, Sieverding L, Breuer J. 31P NMR spectroscopy detects metabolic abnormalities in asymptomatic patients with hypertrophic cardiomyopathy. Circulation. Jun 30 1998;97(25):2536-42. [Medline].

  55. Sieverding L, Jung WI, Breuer J. Proton-decoupled myocardial 31P NMR spectroscopy reveals decreased PCr/Pi in patients with severe hypertrophic cardiomyopathy. Am J Cardiol. Aug 4 1997;80(3A):34A-40A. [Medline].

  56. Maier SE, Fischer SE, McKinnon GC. Evaluation of left ventricular segmental wall motion in hypertrophic cardiomyopathy with myocardial tagging. Circulation. Dec 1992;86(6):1919-28. [Medline].

  57. Kramer CM, Reichek N, Ferrari VA. Regional heterogeneity of function in hypertrophic cardiomyopathy. Circulation. Jul 1994;90(1):186-94. [Medline].

  58. Young AA, Kramer CM, Ferrari VA. Three-dimensional left ventricular deformation in hypertrophic cardiomyopathy. Circulation. Aug 1994;90(2):854-67. [Medline].

  59. Dong SJ, MacGregor JH, Crawley AP. Left ventricular wall thickness and regional systolic function in patients with hypertrophic cardiomyopathy. A three-dimensional tagged magnetic resonance imaging study. Circulation. Sep 1994;90(3):1200-9. [Medline].

  60. Lattanzi F, Spirito P, Picano E. Quantitative assessment of ultrasonic myocardial reflectivity in hypertrophic cardiomyopathy. J Am Coll Cardiol. Apr 1991;17(5):1085-90. [Medline].

  61. Naito J, Masuyama T, Tanouchi J. Analysis of transmural trend of myocardial integrated ultrasound backscatter for differentiation of hypertrophic cardiomyopathy and ventricular hypertrophy due to hypertension. J Am Coll Cardiol. Aug 1994;24(2):517-24. [Medline].

  62. Kaple RK, Murphy RT, DiPaola LM, Houghtaling PL, Lever HM, Lytle BW, et al. Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes. Ann Thorac Surg. May 2008;85(5):1527-35, 1535.e1-2. [Medline].

  63. Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation. Nov 21 2006;114(21):2232-9. [Medline]. [Full Text].

  64. McIntosh CL, Maron BJ, Cannon RO III. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation. Nov 1992;86(5 Suppl):II60-7. [Medline].

  65. Prasad K, Atherton J, Smith GC, McKenna WJ, Frenneaux MP, Nihoyannopoulos P. Echocardiographic pitfalls in the diagnosis of hypertrophic cardiomyopathy. Heart. Nov 1999;82 Suppl 3:III8-III15. [Medline]. [Full Text].

  66. Cannon RO III, Dilsizian V, O'Gara PT. Myocardial metabolic, hemodynamic, and electrocardiographic significance of reversible thallium-201 abnormalities in hypertrophic cardiomyopathy. Circulation. May 1991;83(5):1660-7. [Medline].

  67. Pace L, Betocchi S, Losi MA, Della Morte AM, Ciampi Q, Nugnez R, et al. Sympathetic nervous function in patients with hypertrophic cardiomyopathy assessed by [123I]-MIBG: relationship with left ventricular perfusion and function. Q J Nucl Med Mol Imaging. Mar 2004;48(1):20-5. [Medline].

  68. Nagamatsu H, Momose M, Kobayashi H, Kusakabe K, Kasanuki H. Prognostic value of 123I-metaiodobenzylguanidine in patients with various heart diseases. Ann Nucl Med. Nov 2007;21(9):513-20. [Medline].

  69. Ohtsuki K, Sugihara H, Kuribayashi T, Nakagawa M. Impairment of BMIPP accumulation at junction of ventricular septum and left and right ventricular free walls in hypertrophic cardiomyopathy. J Nucl Med. Dec 1999;40(12):2007-13. [Medline].

  70. Maron BJ, McIntosh CL, Klues HG. Morphologic basis for obstruction to right ventricular outflow in hypertrophic cardiomyopathy. Am J Cardiol. May 1 1993;71(12):1089-94. [Medline].

  71. Smolders W, Rademakers F, Conraads V. Apical hypertrophic cardiomyopathy. Acta Cardiol. 1993;48(4):369-83. [Medline].

  72. Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. Jul 25 2007;298(4):405-12. [Medline]. [Full Text].

  73. McKenna WJ, Behr ER. Hypertrophic cardiomyopathy: management, risk stratification, and prevention of sudden death. Heart. Feb 2002;87(2):169-76. [Medline]. [Full Text].

  74. [Best Evidence] Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications. JAMA. Sep 19 2007;298(11):1312-22. [Medline]. [Full Text].

  75. DeLuca M, Tak T. Hypertrophic cardiomyopathy. Tools for identifying risk and alleviating symptoms. Postgrad Med. Jun 2000;107(7):127-30, 133-5, 139-40. [Medline].

  76. Biagini E, Spirito P, Leone O, Picchio FM, Coccolo F, Ragni L, et al. Heart transplantation in hypertrophic cardiomyopathy. Am J Cardiol. Feb 1 2008;101(3):387-92. [Medline].

  77. Paterick TE, Paterick TJ, Fletcher GF, Maron BJ. Medical and legal issues in the cardiovascular evaluation of competitive athletes. JAMA. Dec 21 2005;294(23):3011-8. [Medline].

  78. Maron BJ, Thompson PD, Puffer JC, McGrew CA, Strong WB, Douglas PS, et al. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) and Congenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation. Aug 15 1996;94(4):850-6. [Medline]. [Full Text].

  79. Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol. Apr 19 2005;45(8):1340-5. [Medline].

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Keywords

hypertrophic cardiomyopathy, idiopathic hypertrophic subaortic stenosis, IHSS, asymmetric septal hypertrophy, muscular subaortic stenosis, hypertrophic obstructive cardiomyopathy, HOCM, HCM

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Contributor Information and Disclosures

Author

Diwaker Agarwal, MD, Staff Physician, Department of Radiology, Mercy Medical Center
Diwaker Agarwal, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center
George Hartnell, MB is a member of the following medical societies: American College of Cardiology, American College of Radiology, American Heart Association, Association of University Radiologists, British Institute of Radiology, British Medical Association, Massachusetts Medical Society, Radiological Society of North America, Royal College of Physicians, Royal College of Radiologists, and Society of Cardiovascular and Interventional Radiology
Disclosure: Nothing to disclose.

Medical Editor

Justin D Pearlman, MD, PhD, ME, MA, Director of Advanced Cardiovascular Imaging, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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