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Understanding HCM

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How Well Do You Know HCM?

How well do you know HCM?

Ready to test your HCM knowledge? Choose the correct answer from the choices provided. At the end you’ll be able to see how you stack up against your peers. Ready? All results are anonymous.

QUESTION 1:

What percentage of adults with hypertrophic cardiomyopathy (HCM) in the United States are undiagnosed?

A.

B.

C.

QUESTION 1:

What percentage of adults with hypertrophic cardiomyopathy (HCM) in the United States are undiagnosed?

A.

60%

B.

85%

C.

40%

The correct answer is “B.” Estimates suggest that at least one in 500 adults in the United States may have HCM. Rates of HCM are similar across ethnic groups, though its prevalence increases with age.1-3 In addition, only about 100,000 adults in the United States have been diagnosed with HCM, suggesting that as many as 85% may remain undiagnosed.4

QUESTION 2:

What is believed to be the key underlying pathophysiology of hypertrophic cardiomyopathy (HCM)?

A.

B.

C.

QUESTION 2:

What is believed to be the key underlying pathophysiology of hypertrophic cardiomyopathy (HCM)?

A.

Hypercontractility due to excess actin and myosin cross-bridging

B.

Disordered myocyte formation

C.

Excess intracellular calcium leading to increased cardiomyocyte contraction

The correct answer is “A.” HCM begins insidiously in the myocardium and affects the structure and functionality of the heart.3,5,6 Specifically, it alters cardiac myocytes—the very source of contraction—at the level of the sarcomere, which is the site of actin and myosin cross-bridging.5,7 In HCM, excessive actin–myosin cross-bridging is observed, and this leads to hypercontractility.7-9

QUESTION 3:

Which of the following symptoms are most commonly associated with hypertrophic cardiomyopathy (HCM)?

A.

B.

C.

D.

E.

QUESTION 3:

Which of the following symptoms are most commonly associated with hypertrophic cardiomyopathy (HCM)?

A.

Shortness of breath

B.

Palpitations

C.

Rapid heart rate

D.

All of the above

E.

A and B

The correct answer is “E.” Patients with HCM may present with dyspnea, especially on exertion; palpitations; fatigue; chest pain; and syncope.5,10 With these symptoms mimicking those of several other cardiovascular and pulmonary conditions, HCM is often masked and difficult to diagnose.11,12 As with any disease, a delayed or missed hypertrophic cardiomyopathy diagnosis can put a patient’s health at risk.

QUESTION 4:

Due to its nonspecific symptoms, hypertrophic cardiomyopathy (HCM) can masquerade as which of the following conditions?

A.

B.

C.

D.

E.

QUESTION 4:

Due to its nonspecific symptoms, hypertrophic cardiomyopathy (HCM) can masquerade as which of the following conditions?

A.

Asthma

B.

Anxiety

C.

Heart failure

D.

All of the above

E.

B and C

The correct answer is “D.” HCM shares symptoms with other common cardiovascular and pulmonary diseases, such as heart failure (HF), arrythmia (eg, atrial fibrillation), hypertensive heart disease, asthma, and chronic obstructive pulmonary disease.13-18 Although HCM may be initially misdiagnosed as HF due to the overlap of symptoms between the two conditions, it is also worthwhile to note that it can also lead to HF.5 In fact, 22% to 45% of patients with HCM develop HF.19-21 In this respect, it is critical to use the correct tests (eg, echocardiogram, electrocardiography) from the onset to confirm HCM.5,22

QUESTION 5:

Based on current published literature, what percentage of patients with hypertrophic cardiomyopathy (HCM) demonstrate left ventricular (LV) outflow tract obstruction only upon exertion?

A.

B.

C.

QUESTION 5:

Based on current published literature, what percentage of patients with hypertrophic cardiomyopathy (HCM) demonstrate left ventricular (LV) outflow tract obstruction only upon exertion?

A.

~15%

B.

~33%

C.

~75%

The correct answer is “B.” Diagnosis of HCM is challenging given its heterogeneous presentation, which generally consists of two HCM subtypes: obstructive HCM (oHCM, OHCM, or HOCM) and nonobstructive HCM (NHCM). oHCM occurs when thickening of the ventricular septum causes a dynamic narrowing that can block or reduce blood flow from the LV to the aorta, resulting in LV outflow tract (LVOT) obstruction.23 In nHCM, cardiac wall thickening occurs without restricting blood flow.24 The prevalence of oHCM is 70%, with 37% demonstrating LVOT at rest and another 33% showing LVOT only upon exercise challenge.25 Understanding this nuance and its impact on how testing should be conducted is critical because the presence of LVOT is associated with increased risk of sudden cardiac death.26,27

QUESTION 6:

When assessing the presence of left ventricular outflow tract (LVOT) obstruction via echocardiography, which approach would be most helpful to evaluate dynamic LVOT gradients?

A.

B.

C.

D.

E.

QUESTION 6:

When measuring left ventricular outflow tract (LVOT) gradients via echocardiography in a patient with hypertrophic cardiomyopathy (HCM), what should be done first?

A.

Resting echocardiography

B.

Valsalva maneuver

C.

Stress echocardiography

D.

B or C

E.

A or B

The correct answer is “D.” Cardiac imaging, such as echocardiography, can reveal anatomic abnormalities consistent with HCM.28 Stress echocardiography, which was previously underutilized due to concern about arrhythmic risk or hemodynamic collapse, is now the preferred standard for measuring LVOT gradients in patients with HCM.28,29 Its use has not been linked with increased cardiovascular risk when performed in a monitored and controlled setting.29 The Valsalva maneuver may be the alternative choice to exercise echocardiography if comorbidities are a concern.29

How well do you know HCM?

Enter your email address below to see how you scored and compared against your peers.

How well do you know HCM?

YOU SCORED:

5 of 6

CORRECTLY

83%

YOUR PEERS:

YOU SCORED HIGHER THAN:

72%

OF YOUR PEERS

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