Differential Diagnosis
- Single most likely diagnosis + Hypertrophic Cardiomyopathy (HCM): The presence of a mild concentric left ventricular hypertrophy and an increase in the left ventricular outflow tract (LVOT) gradient with Valsalva maneuver (from 7 to 19 mmHg) is suggestive of HCM, particularly the obstructive form. The small left ventricular size also supports this diagnosis.
- Other Likely diagnoses + Athletic Heart Syndrome: This condition can present with mild left ventricular hypertrophy and a small left ventricular size due to intense physical training. However, the increase in LVOT gradient with Valsalva is less typical for athletic heart syndrome. + Systemic Hypertension: Long-standing hypertension can lead to concentric left ventricular hypertrophy. The resting and Valsalva-induced LVOT gradients could be seen in the context of systemic hypertension, although they are not as characteristic as in HCM.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Aortic Stenosis: Although the gradients provided are not typically high for severe aortic stenosis, any degree of aortic stenosis can be significant and needs to be ruled out, especially in older patients or those with symptoms suggestive of aortic stenosis. + Cardiac Amyloidosis: This condition can present with left ventricular hypertrophy and may have a restrictive filling pattern. While the LVOT gradients are not typical, cardiac amyloidosis is a serious condition that requires consideration due to its poor prognosis if untreated.
- Rare diagnoses + Fabry Disease: A genetic disorder that can lead to left ventricular hypertrophy. It's less likely given the specific findings but should be considered in patients with unexplained left ventricular hypertrophy, especially if there's a family history. + Left Ventricular Non-Compaction: A rare cardiomyopathy characterized by a spongy appearance of the left ventricle. It might present with hypertrophy and could potentially cause outflow tract obstruction, although this is less common.