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{{Hypertrophic cardiomyopathy}}
{{Hypertrophic cardiomyopathy}}


'''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org]
'''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] {{AE}}{{Soroush}}


==Overview==
==Overview==
The symptoms associated with hypertrophic cardiomyopathy are quite variable and range from no symptoms, to the development of [[heart failure]], to the occurrence of [[sudden cardiac death]]. The symptoms may vary tremendously from individual even within a family. The timing of symptom onset is quite variable as well and may range from infancy to adulthood.
A large number of the patients with hypertrophic cardiomyopathy are [[asymptomatic]] or complain of mild nonspecific [[symptoms]], Patients are often diagnosed by family [[Screening (medicine)|screening]], incidental [[Heart murmur|murmur]] auscultation during routine examination or screening for school athletic events, or via an abnormal [[The electrocardiogram|ECG]]. Nevertheless, in [[symptomatic]] patients, [[left ventricular]] outflow tract gradients and result in symptoms of [[dyspnea]], [[fatigue]], [[chest pain]], and [[syncope]] are the most common presentations. The symptoms associated with hypertrophic cardiomyopathy are quite variable and range from no [[symptoms]], to the development of [[heart failure]], to the occurrence of [[sudden cardiac death]]. The [[symptoms]] may vary tremendously from individual even within a family. The timing of [[symptom]] onset is quite variable as well and may range from infancy to adulthood.


==What are the symptoms of Hypertrophic cardiomyopathy?==
==Symptoms==
*Some patients have no symptoms. They may not even realize they have the condition until it is found during a routine medical exam
A large number of the patients with hypertrophic cardiomyopathy are [[asymptomatic]] or complain of mild nonspecific [[symptoms]], Patients are often diagnosed by family [[Screening (medicine)|screening]], incidental [[Heart murmur|murmur]] auscultation during routine examination or screening for school athletic events, or via an abnormal [[The electrocardiogram|ECG]]. Nevertheless, in [[symptomatic]] patients, [[left ventricular]] outflow tract gradients and result in symptoms of [[dyspnea]], [[fatigue]], [[chest pain]], and [[syncope]] are the most common presentations.Although most of the patients with hypertrophic cardiomyopathy are [[asymptomatic]], patients may develop one or more of the following [[symptoms]]:<ref name=":0">Maron BJ. Hypertrophic cardiomyopathy. Lancet 1997;350:127–33.</ref><ref name=":1">Maron BJ. Hypertrophic cardiomyopathy. A systematic review. JAMA 2002;287:1308–20.</ref><ref name=":2">Maki S, Ikeda H, Muro A et al. Predictors of sudden cardiac death in
 
hypertrophic cardiomyopathy. Am J Cardiol 1998;82:774–8.</ref><ref name=":3">Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United
*[[Chest pain]] (sometimes known as ''[[Angina pectoris|angina]]'')
States cohort. JAMA 1999;281:650–5.</ref><ref name=":4">Maron BJ, Olivotto I, Bellone P et al. Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39:301–7.</ref> <ref name=":5">Maron BJ. Hypertrophic cardiomyopathy. A systematic review. JAMA 2002;287:1308–20.</ref><ref name=":6">Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999;281:650–5.</ref><ref name=":7">Fay WP, Taliercio CP, Ilstrup DM, Tajik AJ, Gersh BJ. Natural history of hypertrophic cardiomyopathy in the elderly. J Am Coll Cardiol 1990;16:821–6.</ref><ref name=":8">Takagi E, Yamakado T, Nakano T. Prognosis of completely asymptomatic adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999;33:206–11.</ref>
*[[Chest pain]] (also known as [[Angina pectoris|angina]])
*[[Congestive heart failure]] symptoms including [[exercise intolerance]] and [[dyspnea]].
*[[Dizziness]]
*[[Dizziness]]
*[[Dyspnea]] ([[shortness of breath]])
*[[Dyspnea]] ([[shortness of breath]]) which is due to increased stiffness of the [[hypertrophied left ventricle]]. This [[hypertrophy of the left ventricle]] impairs the filling of the [[left ventricle]] and leads to elevated filling pressure in the [[left ventricle]] and the [[left atrium]]. [[Symptoms]] are not closely related to the presence or severity of the [[left ventricular]] outflow tract gradient.
*[[Fainting]] or [[syncope]], especially during exercise
*[[Exercise intolerance]]
*[[Fainting]], [[presyncope]] or frank [[syncope]], especially during exercise
*[[Fatigue]]  
*[[Fatigue]]  
*[[Heart failure]] (in some patients)
*[[Heart failure]] (in some patients)
Line 22: Line 25:
*[[Shortness of breath]] when lying down ([[orthopnea]])
*[[Shortness of breath]] when lying down ([[orthopnea]])
*[[Sudden cardiac death]]
*[[Sudden cardiac death]]
==Specific Symptoms==
[[Dyspnea]] is largely due to increased stiffness of the [[left ventricle]], which impairs filling of the ventricles and leads to elevated pressure in the left ventricle and left atrium. Symptoms are not closely related to the presence or severity of an outflow tract gradient
<ref name="Braunwauld 2005">Braunwauld E. The Cardiomyopathies, in Braunwald's ''Heart Disease'', 7th ed, D Zipes, et al (eds). Philadelphia, Saunders, 2005</ref>. Oftentimes, symptoms mimic those of [[congestive heart failure]] (esp. activity intolerance & dyspnea), but it must be noted that treatment is very different. To treat with diuretics (a mainstay of [[CHF]] treatment) will exacerbate symptoms in hypertrophic cardiomyopathy by decreasing ventricular volume and increasing outflow resistance.
Risk factors for sudden death in individuals with HCM include a young age at first diagnosis (age < 30 years), an episode of aborted sudden death, a family history of HCM with sudden death of relatives, specific mutations in the genes encoding for troponin T and myosin, sustained [[supraventricular tachycardia|supraventricular]] or [[ventricular tachycardia]], recurrent [[syncope]], ventricular septal wall thickness over 3 cm, hypotensive response to exercise, [[syncope]] (especially in children), and bradyarrhythmias (slow rhythms of the heart)<ref name="Maron, Cecchi et al 1994">Maron BJ, Cecchi F, McKenna WJ. Risk factors and stratification for sudden cardiac death in patients with hypertrophic cardiomyopathy. ''[[British Heart Journal|Br Heart J]]''. 1994 Dec; '''72'''(6 Suppl):S13–8. ([http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7873317 Medline abstract]) and the Task Force on Sudden Cardiac Death of the European Society of Cardiology [http://www.guideline.gov/summary/summary.aspx?doc_id=2977 link] Note: Guideline withdraw</ref>


==References==
==References==

Latest revision as of 16:13, 6 February 2020

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Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

A large number of the patients with hypertrophic cardiomyopathy are asymptomatic or complain of mild nonspecific symptoms, Patients are often diagnosed by family screening, incidental murmur auscultation during routine examination or screening for school athletic events, or via an abnormal ECG. Nevertheless, in symptomatic patients, left ventricular outflow tract gradients and result in symptoms of dyspnea, fatigue, chest pain, and syncope are the most common presentations. The symptoms associated with hypertrophic cardiomyopathy are quite variable and range from no symptoms, to the development of heart failure, to the occurrence of sudden cardiac death. The symptoms may vary tremendously from individual even within a family. The timing of symptom onset is quite variable as well and may range from infancy to adulthood.

Symptoms

A large number of the patients with hypertrophic cardiomyopathy are asymptomatic or complain of mild nonspecific symptoms, Patients are often diagnosed by family screening, incidental murmur auscultation during routine examination or screening for school athletic events, or via an abnormal ECG. Nevertheless, in symptomatic patients, left ventricular outflow tract gradients and result in symptoms of dyspnea, fatigue, chest pain, and syncope are the most common presentations.Although most of the patients with hypertrophic cardiomyopathy are asymptomatic, patients may develop one or more of the following symptoms:[1][2][3][4][5] [6][7][8][9]

References

  1. Maron BJ. Hypertrophic cardiomyopathy. Lancet 1997;350:127–33.
  2. Maron BJ. Hypertrophic cardiomyopathy. A systematic review. JAMA 2002;287:1308–20.
  3. Maki S, Ikeda H, Muro A et al. Predictors of sudden cardiac death in hypertrophic cardiomyopathy. Am J Cardiol 1998;82:774–8.
  4. Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999;281:650–5.
  5. Maron BJ, Olivotto I, Bellone P et al. Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002;39:301–7.
  6. Maron BJ. Hypertrophic cardiomyopathy. A systematic review. JAMA 2002;287:1308–20.
  7. Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999;281:650–5.
  8. Fay WP, Taliercio CP, Ilstrup DM, Tajik AJ, Gersh BJ. Natural history of hypertrophic cardiomyopathy in the elderly. J Am Coll Cardiol 1990;16:821–6.
  9. Takagi E, Yamakado T, Nakano T. Prognosis of completely asymptomatic adult patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1999;33:206–11.