Hypertrophic cardiomyopathy physical examination

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

Overview

There are numerous findings on physical examination that allow one to distinguish hypertrophic cardiomyopathy from other conditions such as aortic stenosis. On physical examination, (as shown in the table below) maneuvers that decrease left ventricular filling augment the murmur and maneuvers that increase afterload or filling decrease the murmur.

Physical Examination

  • The physical findings of HCM are associated with the dynamic outflow obstruction that is often present with this disease.[1][2][3][4][5] [6][7][8][9]

Appearance of the Patient

  • Patients with hypertrophic cardiomyopathy usually appear normal.

Vital Signs

  • Tachycardia with regular pulse or (ir)regularly irregular pulse
  • Patients with hypertrophic cardiomyopathy are prone to arrhythmia

Skin

  • Skin examination of patients with hypertrophic cardiomyopathy is usually normal.

HEENT

  • HEENT examination of patients with hypertrophic cardiomyopathy is usually normal.

Neck

Lungs

  • Pulmonary examination of patients with hypertrophic cardiomyopathy is usually normal.

Heart

Palpation

  • Powerful apical precordial impulse is present which may be shifted laterally.

Auscultation

Heart Sounds
Murmurs
  • increase in intensity with any maneuver that decreases the volume of blood in the left ventricle (such as standing, valsalva maneuver, amyl nitrate, diuretic administration or vasodilator administration).
  • decrease in intensity with any maneuver that increases the volume of blood in the left ventricle (such as Mueller maneuver, squatting or handgrip).
Differentiating hypertrophic cardiomyopathy and valvular aortic stenosis
  Aortic stenosis Hypertrophic cardiomyopathy
Echocardiography
Aortic valve calcification Common No
Dilated ascending aorta Common Rare
Ventricular hypertrophy Concentric LVH Asymmetric, often involving the septum
Physical examination
Murmur of AI Common No
Pulse pressure after PVC Increased Decreased
Valsalva maneuver Decreased intensity of murmur Increased intensity of murmur
Carotid pulsation Normal or tardus et parvus Brisk, jerky, or bisferiens pulse (a collapse of the pulse followed by a secondary rise)


Abdomen

  • Abdominal examination of patients with hypertrophic cardiomyopathy is usually normal.

Back

  • Back examination of patients with hypertrophic cardiomyopathy is usually normal.

Genitourinary

  • Genitourinary examination of patients with hypertrophic cardiomyopathy is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with hypertrophic cardiomyopathy is usually normal.

Extremities

  • Extremities examination of patients with hypertrophic cardiomyopathy is usually normal.


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.



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