7. HCM / HOCM — POCUS RECOGNITION

7.1 POCUS findings

LV cavity: small, hyperdynamic; near-complete systolic obliteration [1,2].

Wall thickness: 15 mm or greater maximal POCUS practical; asymmetric septal or apical [1,3].

Septal/posterior ratio: greater than 1.3 normotensive; greater than 1.5 hypertensive [1,3].

SAM of mitral valve: M-mode/PLAX; dynamic LVOT narrowing in systole [1,2].

LVOT obstruction: dynamic; worsens with reduced preload, increased contractility, vasodilation, tachycardia [1,4].

Cavity response to fluid: LVIDd increases; obstruction improves [2,4].

7.2 Immediate management

Fluids if underfilled [4].

Avoid nitrates, vasodilators, diuretics, and inotropes [4].

Beta-blockers judiciously: reduce rate, reduce contractility, increase filling time [4].

Formal echo plus cardiology urgently [1,2].

7.3 Long-term

Risk stratification. ICD consideration. Genetic counselling. Septal reduction therapy in selected patients [1,2,5].

POCUS can suggest HCM/HOCM. Formal echo is required for definitive diagnosis, gradient quantification, and risk stratification [1,2]. Apical HCM may be missed on basic POCUS.

7.4 Pitfalls

None HCM-specific. Hyperdynamic-state pitfall housed in S2.7.

References

  1. Stoll CM, Carr M, Naraghi L. Hypertrophic cardiomyopathy diagnosed on point-of-care echocardiogram in an elderly patient with syncope. Cureus. 2021;13(8):e17008.

  2. Dabo-Trubelja A, Fischer GW. Case report: point of care ultrasound for bedside diagnosis of hypertrophic cardiomyopathy in the post-anesthesia care unit. SN Compr Clin Med. 2025;7:257. doi:10.1007/s42399-025-02010-2.

  3. Stoica R, Heller EN, Bella JN. Point-of-care screening for left ventricular hypertrophy and concentric geometry using hand-held cardiac ultrasound in hypertensive patients. Am J Cardiovasc Dis. 2011;1(2):119-125.

  4. Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150(19):e351-e442. doi:10.1161/CIR.0000000000001285.

  5. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020;142:e558-e631.