TABLE 3.
Clinical and echocardiographic characteristics of alternative causes of left ventricular hypertrophy beyond cardiac amyloidosis.
| Hypertrophic disease | Clinical clues | Echocardiographic clues |
| Fabry disease | Childhood to adulthood | Concentric/symmetric LVH |
| X-linked inheritance | Papillary hypertrophy | |
| Abdominal pain | Papillary position variants | |
| Angiokeratomas | RV hypertrophy | |
| Kidney abnormalities | Regional strain abnormalities | |
| Hypohidrosis | Occasional areas of LV thinning | |
| Conduction disease | ||
| Hypertrophic cardiomyopathy | Childhood to adulthood | Most commonly asymmetric LVH |
| Sudden cardiac death | Apical/mid-cavity variants | |
| Often inherited | Apical aneurysm | |
| ECG pattern often | Papillary position variants | |
| characteristic | MV abnormalities | |
| Mitral regurgitation | ||
| Hypertensive heart disease (HHD) | Long-standing documented HTN | Non-specific |
| Strong family history HTN | ||
| Multiple anti-hypertensives | ||
| Athlete’s heart | Endurance/high-intensity exercise | Eccentric hypertrophy (LV dilation) |
| Resting bradycardia | RV dilation/hypertrophy | |
| Atrial dilation | ||
| Non-compaction sometimes seen | ||
| Friedreich ataxia | Usually childhood/adolescent | Asymmetric or concentric LVH |
| Autosomal recessive | Dilated variants | |
| Gait ataxia | ||
| Vision/hearing problems | ||
| Nystagmus | ||
| Danon disease | Childhood/adolescent | Non-compaction |
| X-linked inheritance | ||
| Skeletal myopathy | ||
| Cognitive impairment | ||
| Pre-excitation on ECG | ||
| Left ventricular non-compaction (LVNC) | Childhood to adulthood | Non-compaction |
| Thromboembolic events | Colour Doppler of hypertrophy for flow | |
| Malignant arrhythmias | Contrast usage may help | |
| Hypereosinophilic cardiomyopathy | Hypereosinophilic state | Restrictive |
| Thromboembolic events | Endomyocardial thickening | |
| Fulminant to indolent | LV/RV thrombi | |
| MV/TV entrapment | ||
| Mitochondrial cardiomyopathies | Childhood | Non-compaction |
| Often maternal inheritance | ||
| Multiple distinct syndromes | ||
| Myopathy | ||
| Stressors worsen symptoms | ||
| RASopathies | Childhood | Other heart defects |
| (Noonan, etc.) | Myopathy | |
| Developmental delay | ||
| Often characteristic appearance |
HTN, hypertension; LV, left ventricle; LVH, left ventricular hypertrophy; MV, mitral valve; RV, right ventricle; TV, tricuspid valve.