Case Details

• Pulse is jerky

• The heart

• Aortic stenosis

• ECG: LVH and T-wave inversion in most leads
• Cardiac MRI
• Genetic testing: sarcomeric protein mutation
• TTE: asymmetrical septal hypertrophy and systolic anterior motion (SAM) of anterior mitral leaflet

Asymptomatic

• Avoid strenuous exercise
• Avoid vasodilators and dehydration

Symptomatic + LVOT gradient > 30 mmHg

• Beta-blocker
• Pacemaker
• Alcohol septal ablation
• Surgical myomectomy

• ICD
• Heart transplant

• Young age at diagnosis
• Family history of sudden death
• Syncope
• Septal thickness > 3 cm

• Genetic counseling for first-degree relatives as this condition is autosomal dominant
• Include HOCM in differential diagnosis of murmurs of AS, MR, MVP and VSD