HCM / HOCM - POCUS Recognition

POCUS findings

• LV cavity: small, hyperdynamic; near-complete systolic obliteration.

• Wall thickness: 15 mm or greater maximal POCUS practical; asymmetric septal or apical.

• Septal/posterior ratio: greater than 1.3 normotensive; greater than 1.5 hypertensive.

• SAM of mitral valve: M-mode/PLAX; dynamic LVOT narrowing in systole.

• LVOT obstruction: dynamic; worsens with reduced preload, increased contractility, vasodilation, tachycardia.

• Cavity response to fluid: LVIDd increases; obstruction improves.

Immediate management

• Fluids if underfilled.

• Avoid nitrates, vasodilators, diuretics, and inotropes.

• Beta-blockers judiciously: reduce rate, reduce contractility, increase filling time.

• Formal echo plus cardiology urgently.

Long-term

• Risk stratification.

• ICD consideration.

• Genetic counselling.

• Septal reduction therapy in selected patients.

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