Differentials
Athlete's heart
SIGNS / SYMPTOMS
Patient will typically be a male endurance athlete without cardiac symptoms.
No family history of HCM or sudden death.
Hypertrophy will regress with cessation of exercise.[53]
INVESTIGATIONS
Echocardiography: will characteristically show increased left ventricular (LV) chamber dimension (LV end-diastolic dimension or LV end-diastolic >55 mm), symmetrical left ventricular hypertrophy (LVH) with a homogeneous-appearing myocardium.
Wall thicknesses may occasionally exceed upper normal limits (12 mm).[53]
LV filling pattern is most often normal.[53]
The use of late gadolinium enhancement techniques may aid in differentiating HCM from an athletic heart.[31]
Discrete subaortic stenosis
SIGNS / SYMPTOMS
No family history of HCM or sudden death.
Not associated with sudden death. Systolic murmur is typically present in all positions (i.e., supine and squatting).
INVESTIGATIONS
Echocardiography: symmetrical left ventricular hypertrophy; aortic valve closure early in systole and persistent valve closure throughout the rest of systole; coarse fluttering of the aortic valve leaflets.[54]
LVH due to hypertension
SIGNS / SYMPTOMS
History of long-standing hypertension.
INVESTIGATIONS
Echocardiography: most commonly concentric left ventricular hypertrophy or remodelling with varying degrees of diastolic dysfunction depending on the severity and duration of hypertension.[27]
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