Hypertrophic cardiomyopathy differential diagnosis

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1], Cafer Zorkun, M.D. [2], Caitlin J. Harrigan [3], Martin S. Maron, M.D., and Barry J. Maron, M.D.

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Clinical diagnosis of HCM is most easily and readily established with 2-dimensional echocardiography, by imaging the hypertrophied but nondilated LV chamber, in the absence of another cardiac or systemic disease capable of producing the magnitude of hypertrophy evident.

Differential Diagnosis

HCM must be distinguished from the following disorders:

1. 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