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Hypertrophic cardiomyopathy — ABIM Board MCQ

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HardCardiovascularHypertrophic cardiomyopathyABIM Board

A 29-year-old man with hypertrophic cardiomyopathy has exertional presyncope despite a resting LV outflow gradient of 18 mm Hg. Valsalva raises the gradient to 28 mm Hg, and ambulatory monitoring shows no arrhythmia during symptoms. Which test should next assess the suspected dynamic obstruction?

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Correct answer: D — Perform exercise stress echocardiography with LV outflow-gradient measurement

The best answer is “Perform exercise stress echocardiography with LV outflow-gradient measurement”. In a symptomatic patient whose resting and bedside-provoked gradients remain below 50 mm Hg, exercise echocardiography can reproduce physiologic loading conditions and identify clinically important provocable obstruction. The competing tests do not quantify exercise-related LV outflow gradients.

Reference: 2024 AHA/ACC Multisociety Guideline for Hypertrophic Cardiomyopathy: https://pubmed.ncbi.nlm.nih.gov/38718139/