In a patient with presyncope and a systolic murmur, cardiac imaging showing left ventricular (LV) wall thickness ≥15 mm with LV outflow tract (OT) obstruction raises suspicion for obstructive hypertrophic cardiomyopathy (HCM). Resting LVOT gradients >30 mm Hg, as seen in this patient, are associated with progressive heart failure and worse outcomes. A heart with obstructive HCM should work smarter, not harder. First-line therapy includes beta-blockers or nondihydropyridine calcium-channel blockers, while cardiac myosin inhibitors reduce myocardial hypercontractility. If symptoms persist, surgical myomectomy or alcohol septal ablation should be considered. For more details, see this NEJM review article.
Comment
In a patient with presyncope and a systolic murmur, cardiac imaging showing left ventricular (LV) wall thickness ≥15 mm with LV outflow tract (OT) obstruction raises suspicion for obstructive hypertrophic cardiomyopathy (HCM). Resting LVOT gradients >30 mm Hg, as seen in this patient, are associated with progressive heart failure and worse outcomes. A heart with obstructive HCM should work smarter, not harder. First-line therapy includes beta-blockers or nondihydropyridine calcium-channel blockers, while cardiac myosin inhibitors reduce myocardial hypercontractility. If symptoms persist, surgical myomectomy or alcohol septal ablation should be considered. For more details, see this NEJM review article.