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Cardiomyopathy, Hypertrophic: Multimedia
Updated: Apr 7, 2009
Multimedia
 | Media file 1: Cardiomyopathy, hypertrophic. Axial electrocardiographically (ECG) gated spin-echo MRI in a patient shows marked septal (S) and less-prominent posterior wall thickening. |
 | Media file 2: Cardiomyopathy, hypertrophic. Oblique axial cine magnetic resonance angiogram in the same patient as in Image above shows a spade-shaped left ventricle with relative sparing of the apical myocardium (arrow). |
 | Media file 3: Cardiomyopathy, hypertrophic. Short-axis cine end-diastolic magnetic resonance angiogram shows asymmetric hypertrophy with septal thickening (S). |
 | Media file 4: Cardiomyopathy, hypertrophic. Short-axis cine end-systolic, magnetic resonance angiogram obtained in the same patient as in Image above shows marked myocardial thickening that affects the entire myocardium. |
 | Media file 5: Cardiomyopathy, hypertrophic. Oblique cine magnetic resonance angiogram (outflow 2-chamber view equivalent to a long-axis echocardiogram) shows an area of signal intensity loss (white arrow) in the left ventricular outflow tract, where an obstruction between the hypertrophied septum and anterior mitral leaflet is present. The obstruction is well below the aortic valve ring (between black arrows). |
 | Media file 6: Cardiomyopathy, hypertrophic. Oblique cine magnetic resonance angiogram (outflow 2-chamber view) shows prolapse (arrow) of the posterior mitral leaflet in early systole. |
 | Media file 7: Cardiomyopathy, hypertrophic. Oblique cine magnetic resonance angiogram (outflow 2-chamber view obtained during the same study as Image above) shows mitral prolapse of the posterior mitral leaflet with a small signal intensity loss due to mitral regurgitation (arrow). |
 | Media file 8: Cardiomyopathy, hypertrophic. M-mode echocardiogram recorded at the level of the tips of the mitral valve (horizontal arrows) to assess left ventricular dimensions shows moderate thickening of both the septum (S) and posterior wall of the left ventricle (PW). |
 | Media file 9: Cardiomyopathy, hypertrophic. Axial 2-dimensional echocardiogram obtained in the same patient as in Image 8 shows asymmetric septal thickening (23 mm) and a small left ventricular cavity (LV). |
 | Media file 10: Cardiomyopathy, hypertrophic. M-mode echocardiogram recorded at the level of the mitral valve shows a small ventricular cavity (arrow) and systolic anterior motion of the anterior mitral valve leaflet (*). |
 | Media file 11: Cardiomyopathy, hypertrophic. M-mode echocardiogram recorded at the level of the mitral valve in a patient with extreme septal hypertrophy (>40 mm) shows a small ventricular cavity (3 cm) and systolic anterior motion of the anterior mitral valve leaflet (*). |
 | Media file 12: Cardiomyopathy, hypertrophic. M-mode echocardiogram recorded at the level of the aortic valve in the same patient as in Image 8 shows high-frequency flutter on the aortic leaflets (arrows). |
 | Media file 13: Cardiomyopathy, hypertrophic. Continuous-wave Doppler image shows a typical concave profile (arrows) compared with the systolic waveform recorded from the left ventricular outflow; this finding represents subvalvular dynamic outflow obstruction. |
 | Media file 14: Cardiomyopathy, hypertrophic. Stress (top row) and rest (bottom row) technetium-99m Sesta-2-methoxy-isobutyl-isonitrile (MIBI) perfusion images of hypertrophic cardiomyopathy shows a reversible septal perfusion defect that is not related to coronary obstruction. The septum is markedly thickened (4 cm on the echocardiogram). |
 | Media file 15: Cardiomyopathy, hypertrophic. Pressure tracing obtained as the catheter is pulled back from the center of the left ventricle to the aortic root shows a reduction in systolic pressure (arrow 1) in the left ventricle; this finding indicates a subaortic gradient. The waveform changes at the level of the aortic valve, but the systolic pressure does not change (arrow 2). Note the spike-and-dome configuration of the left ventricular pressure tracing. |
 | Media file 16: Cardiomyopathy, hypertrophic. End-diastolic right anterior oblique digital subtraction left ventriculogram shows the normal size and shape of the left ventricle in a patient with hypertrophic cardiomyopathy. |
 | Media file 17: Cardiomyopathy, hypertrophic. End-diastolic right anterior oblique digital subtraction left ventriculogram obtained in the same study as Image above shows a small cavity, with prominent papillary muscles (arrows) projecting into the remains of the ventricular cavity. |
 | Media file 18: Cardiomyopathy, hypertrophic. The 2 images above are used to calculate function and left ventricular dimensions. The outline of the end-diastolic image (Image 16 in Multimedia) has been superimposed on the systolic image (Image 17 in Multimedia). Ejection fractions were calculated by using the area-length method (ejection fraction, 86%) and the Simpson rule (ejection fraction, 84%). The videodensitometric technique shown is inaccurate because of incorrect background registration. |
 | Media file 19: Cardiomyopathy, hypertrophic. Conventional end-diastolic right anterior oblique left ventriculogram acquired during cardiac catheterization shows the normal size and shape of the left ventricle in a patient with hypertrophic cardiomyopathy. Note the distance between the ventricular cavity and the coronary arteries (arrows), which define the epicardial surface of the heart. This distance indicates considerable thickening of the myocardium. |
 | Media file 20: Cardiomyopathy, hypertrophic. Conventional end-systolic right anterior oblique left ventriculogram acquired during the same cardiac catheterization study as in Image above shows a small left-ventricular cavity with mild mitral regurgitation (M). Note the increased distance between the ventricular cavity and the coronary arteries (arrows), which define the epicardial surface of the heart as the myocardium becomes thickened in systole. |
 | Media file 21: Cardiomyopathy, hypertrophic. Conventional right anterior oblique aortogram acquired during cardiac catheterization in the same patient as in Image above shows unobstructed coronary arteries. |
More on Cardiomyopathy, Hypertrophic |
| Overview: Cardiomyopathy, Hypertrophic |
| Imaging: Cardiomyopathy, Hypertrophic |
| Follow-up: Cardiomyopathy, Hypertrophic |
 Multimedia: Cardiomyopathy, Hypertrophic |
| References |
| Further Reading |
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Further Reading
Related eMedicine topics
Cardiomyopathy, Hypertrophic (Cardiology)
Cardiomyopathy, Hypertrophic (Pediatrics)
Atrial Fibrillation
Sudden Cardiac Death
Aortic Stenosis
Clinical guidelines
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices).
American College of Cardiology Foundation
American Heart Association
Heart Rhythm Society. 1998 Apr (revised 2008 May 27). 62 pages. NGC:006498
Clinical trials
Comparison of Data Obtained by Echocardiography and Magnetic Resonance Imaging in Hypertrophic Cardiomyopathy
Use of Magnetic Field Mapping in the Evaluation of Patients With Hypertrophic Heart Disease (Thick Heart Muscle)
Antiarrhythmic Therapy Versus Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy
Genetic Predictors of Outcome in HCM Patients
Keywords
hypertrophic cardiomyopathy, idiopathic hypertrophic subaortic stenosis, IHSS, asymmetric septal hypertrophy, muscular subaortic stenosis, hypertrophic obstructive cardiomyopathy, HOCM, HCM
