Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes. The majority of patients are asymptomatic or only mildly symptomatic. Syncope and sudden death are associated with severe exertion and competitive sports, which should be avoided in patients with hypertrophic cardiomyopathy. The most common symptom is dyspnoea.



Physical findings
Typical examination findings include left ventricular hypertrophy and a loud S4. Forceful atrial systole causes a double apical impulse.
A triple apical impulse can also occur due to a late systolic bulge. The carotid pulse also demonstrates a late systolic pulse causing the characteristic jerky feature. In contrast to aortic stenosis, the systolic murmur of hypertrophic cardiomyopathy does not radiate to the carotids. Moreover, it decreases on squatting and passive leg elevation and increases with the Valsalva manoeuvre.

ECG
The most common changes seen on the ECG are ST–T wave abnormalities followed by LVH. Q waves may also occur in leads II, III, aVF or V2–V6. The exact cause of the Q waves remains unclear.