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Hypertrophic cardiomyopathy — ABIM Board MCQ

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ModerateCardiovascularHypertrophic cardiomyopathyABIM Board

A 24-year-old collapses during basketball. His father died suddenly at age 39. A harsh systolic murmur at the left lower sternal border increases with standing, and ECG shows left-ventricular hypertrophy with deep septal Q waves. Which initial cardiac imaging study is most appropriate?

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Correct answer: A — Obtain transthoracic echocardiography

The best answer is “Obtain transthoracic echocardiography”. The exertional event, family history and dynamic murmur suggest hypertrophic cardiomyopathy. Transthoracic echocardiography assesses ventricular wall thickness, outflow obstruction and mitral-valve anatomy. Cardiac MRI can refine uncertain or high-risk findings, but pulmonary, carotid, tilt and blood-pressure tests do not define the suspected structural disease.

Reference: 2024 AHA/ACC Multisociety Guideline for Hypertrophic Cardiomyopathy: https://professional.heart.org/en/science-news/2024-guideline-for-the-management-of-hypertrophic-cardiomyopathy