Hypertrophic cardiomyopathy differential diagnosis
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The diagnostic imaging modality of choice is echocardiography. There are multiple echocardiographic features that distinguish hypertrophic cardiomyopathy from other conditions that lead to myocardial hypertrophy. In hypertrophic cardiomyopathy, the left ventricle is not dilated, and there is no other condition that would account for the magnitude of hypertrophy. The hypertrophy is often asymmetric.
Differential Diagnosis
HCM must be distinguished from the following disorders:
Athlete's heart
Several criteria can be used to distinguish these two entities:
The degree of left ventricular wall thickness
- In athlete's heart the LVH is symmetric and less than or equal to 12 mm
- Rarely the LV thickness can be 14-16 mm and this makes it difficult to distinguish from HOCM. Athletes who engage in strength training may develop this pattern, ahtletes who engage in endurance training do not.
- If the degree of thickening is out of proportion to the type and intensity of exercise, this suggests HOCM
The pattern of left ventricular wall thickness
- Athleste's heart is symmetric
- HOCM is more often asymmetric, but may in some cases be symmetric
The left ventricular cavity size
- HOCM has smaller LV cavitary dimensions