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. 1999 Nov;82(Suppl 3):III8–III15. doi: 10.1136/hrt.82.2008.iii8

Echocardiographic pitfalls in the diagnosis of hypertrophic cardiomyopathy

K Prasad, J Atherton, G Smith, W McKenna, M Frenneaux, P Nihoyannopoulos
PMCID: PMC1766516  PMID: 10534325

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Figure 1  .

Figure 1  

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Typical M mode echocardiogram from a patient with hypertrophic cardiomyopathy highlighting the four main echocardiographic features of the condition. (A) Midsystolic closure of the aortic valve (arrowhead); (B) systolic anterior motion of the mitral valve (arrow) and asymmetric left ventricular hypertrophy together with a small, vigorously contracting left ventricle. In frames (C) and (D), the M mode beam passes through the septum and posterior wall beyond the mitral valve, at the level of the papillary muscles and apex, demonstrating the large reduction of left ventricular end systolic dimensions. Reproduced from Nihoyannopoulos and McKenna with permission of Churchill Livingstone.10

Figure 2  .

Figure 2  

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An example of serial short axis, cross sectional views of the left ventricle at three levels—the mitral valve, papillary muscles, and apex—demonstrating the segments of myocardial wall measured routinely in patients with hypertrophic cardiomyopathy in our laboratory. Reproduced from Nihoyannopoulos and McKenna with permission of Churchill Livingstone.10

Figure 3  .

Figure 3  

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Parasternal short axis view of the left ventricle at the mitral valve level demonstrating a typical eccentric form of ventricular hypertrophy localised essentially at the lateral wall and posterior septum, while the anterior and posterior walls are normal. Reproduced from Nihoyannopoulos and McKenna with permission of Churchill Livingstone.10    

Figure 4  .

Figure 4  

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Parasternal long axis view with colour M mode Doppler echocardiography from a patient with hypertrophic cardiomyopathy and a high (90 mmHg) outflow tract gradient. Notice the occurrence of systolic anterior motion of the mitral valve at the same time as the presence of outflow turbulence (arrow), and later into systole, the presence of mitral regurgitation.

Figure 5  .

Figure 5  

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Apical long axis view with colour flow mapping in a patient with hypertrophic cardiomyopathy and a midventricular gradient and an apical aneurysm. Note, on the left, a midventricular narrowing of the left ventricular cavity (arrowheads) and, on the right, the turbulent flow on colour Doppler echocardiography originating at that level. A, apical aneurysm.

Figure 6  .

Figure 6  

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Parasternal long axis view from a patient referred with the echocardiographic diagnosis of hypertrophic cardiomyopathy (HCM). (A) The M mode image showing the normal septal thickness (10 mm). Notice that the measurement excludes the false tendon (arrow), which runs parallel to the septum. (B) The false tendon along the ventricular septum, which was included in the original measurement of 22 mm and led to the wrong diagnosis of HCM.

Figure 7  .

Figure 7  

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Parasternal long axis view from a patient referred with the echocardiographic diagnosis of hypertrophic cardiomyopathy. (A) The M mode image showing the original measurement of 20 mm for the ventricular septum passing obliquely through the angulated (sigmoid) septum. (B) The two dimensional picture with the angulated septum showing the correct measurement of the septum (10 mm).    

Figure 8  .

Figure 8  

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Parasternal long axis from a patient with Friedreich's ataxia demonstrating asymmetric septal hypertrophy. Reproduced with permission from Dutka et al.29

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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