From the Guidelines
Moderate hypertrophy of the interventricular septum is most likely indicative of hypertrophic cardiomyopathy, a genetic heart condition, and requires further evaluation with a comprehensive cardiac assessment. This condition may also result from long-standing high blood pressure, aortic stenosis, or as an adaptive response to increased cardiac workload. The diagnosis of hypertrophic cardiomyopathy (HCM) can be established by imaging, typically with 2D echocardiography or cardiovascular magnetic resonance (CMR), showing a maximal end-diastolic wall thickness of ≥15 mm anywhere in the left ventricle, in the absence of another cause of hypertrophy in adults 1. Some key points to consider in the management of HCM include:
- Comprehensive 2D echocardiography has a primary role in establishing the diagnosis of HCM, determining hypertrophy pattern, presence of LV apical aneurysms, LV systolic and diastolic function, mitral valve function, and presence and severity of LVOTO 1.
- Routine follow-up of patients with HCM is an important part of optimal care, with serial TTE performed every 1 to 2 years to assess for changes in LV systolic and diastolic function, wall thickness, chamber size, LVOTO, and concomitant valvular disease 1.
- Management depends on the cause but may include beta-blockers like metoprolol (starting at 25-50mg twice daily) or calcium channel blockers such as verapamil (120-360mg daily in divided doses) to reduce heart rate and improve filling [@Example@].
- For hypertrophic cardiomyopathy, genetic counseling may be recommended for family members, and the thickened septum can obstruct blood flow from the left ventricle, potentially causing symptoms like shortness of breath, chest pain, palpitations, or fainting, particularly during physical exertion [@Example@].
- Regular cardiac follow-up is essential to monitor for disease progression and adjust treatment as needed [@Example@].
From the Research
Moderate Hypertrophy of the Interventricular Septum
- Moderate hypertrophy of the interventricular septum is indicative of hypertrophic obstructive cardiomyopathy (HOCM) or basal septal hypertrophy (BSH) 2, 3, 4, 5.
- HOCM is a condition characterized by thickening of the heart muscle, which can lead to obstruction of blood flow out of the heart 2, 3, 4.
- BSH, also known as a "basal septal bulge", is a condition where the basal septum is thicker than normal, which can also lead to left ventricular outflow tract (LVOT) obstruction 5.
Diagnosis and Treatment
- Diagnosis of HOCM or BSH is typically made using echocardiography, cardiac MRI, or cardiac catheterization 2, 3, 5.
- Treatment options for HOCM include surgical myectomy, transcoronary alcohol septal ablation, and endocardial septal ablation therapy 2, 3, 4.
- For patients with BSH, treatment may involve pharmacological therapy, such as beta-blockers, to reduce symptoms and improve exercise capacity 5.
Key Findings
- A study published in the Journal of the American Society of Echocardiography found that percutaneous septal ablation was an effective nonsurgical technique for reducing symptoms and outflow gradients in patients with HOCM 2.
- Another study published in Clinical Research in Cardiology found that transcoronary ablation of septal hypertrophy was consistently effective in reducing the gradient in patients with HOCM 3.
- A case report published in Echo Research and Practice highlighted the importance of orthostatic assessment of LVOT gradient in patients with BSH, as significant LVOT obstruction may be unmasked by an orthostatic posture 5.