Post Diagnosis - Additional Tests

The following 3 tests are recommended for nearly all HCM patients.

Holter Monitor

This test is a continuous recording of the heart beat over 24 to 48 hours. A Holter monitor is a simple and safe test which will detect irregularity of the heart beat (otherwise known as arrhythmia). These are small wearable devices.  Upon diagnosis and at regular intervals all patients should have this test.

Exercise Test or Stress Test

The severity of the exercise limitation and the effect of therapy can be assessed with bicycle or treadmill exercise testing. Exercise testing also provides an objective measurement of improvement, stability or deterioration over time. Upon diagnosis and at regular intervals all HCM patients should have this test, with limited exception.

Exercise Test or Stress Test Echo

After the Exercise/Stress test an echocardiogram is preformed to assess the heart after activity.  This can help to determine the degree of “obstruction” in the heart and how the heart responds to stress.  Upon diagnosis and at regular intervals all HCM patients should have this test, with limited exception

Additional Tests that may be ordered

In the event a one of the tests below is recommended, it is advised you speak to a specialist in the field of HCM to ensure the testing is appropriate for you.

Cardiac Catheterization

Patients with breathlessness, which does not respond to therapy, may require cardiac catheterization. In this test a fine tube is passed from a blood vessel (usually in the groin) to the heart using x-ray guidance. Pressures inside the heart are then measured and an x-ray of the heart is taken (angiography) to assess mitral regurgitation and overall function.  Patients who may be at risk for coronary artery disease and those undergoing cardiac surgery should have this preformed.  It is not necessary for all HCM patients to undergo this test.

Coronary Angiography

Patients, who experience chest pain which does not respond to therapy, may require coronary angiography. This is an x-ray of the coronary arteries to determine if they are diseased and it is performed during cardiac catheterization. This test is rarely used in HCM patients.

Electrophysiological Studies

These are a special form of catheterization performed to define the risk of electrical instability which may predispose to sudden death. This test involves the passage of fine wires from the veins in the groin, arm or shoulder to the heart under x-ray guidance. These wires are then used to apply electrical stimuli to record the response of the electrical system of the heart.  Several years ago it was believed this test could help determine risk of sudden cardiac  arrest in HCM, this has been proven to be incorrect.   The results of an EP test have little to no predictive value at determining risk.  This test has largely been abandoned in HCM with the exception of mapping arrhythmias and pre-ICD implantation to assist in setting devices.

Radionuclide Studies

In these tests, a substance producing a very tiny (safe) amount of radioactivity are given by injection. These tests may be used to assess the contraction and filling of the heart and also to estimate its blood supply at rest and on exercise. This test is rarely used in HCM patients.

Citations:

• American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines.Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH 3rd, Spirito P, Ten Cate FJ, Wigle ED; Task Force on Clinical Expert Consensus Documents. American College of Cardiology; Committee for Practice Guidelines. European Society of Cardiology.J Am Coll Cardiol. 2003 Nov 5;42(9):1687-713
• Hypertrophic Cardiomyopathy for Patients, Their Families and Interested Physicians Second Edition: Maron and Salberg, Wiley publishing 2006