Fast Five Quiz: Hypertrophic Cardiomyopathy Presentation and Diagnosis

Jamshid Shirani, MD


July 30, 2021

Patients without LV outflow tract obstruction may have normal physical examination findings. The classic presentation of HCM, however, is a systolic murmur, prominent apical point of maximal impulse, abnormal carotid pulse, and a fourth heart sound. Systolic ejection murmur, typically a crescendo-decrescendo murmur, is best heard between the apex and left sternal border, but it radiates to the suprasternal notch and not to the carotid arteries or neck.

S3 gallop is common in children with HCM but signifies decompensated congestive heart failure in adults.

Physical findings of outflow tract obstruction should be brought about both at rest and with provocative maneuvers (eg Valsalva maneuver and standing from the squatting position).

For additional information, refer to the 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

Learn more about physical examination in HCM.


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