Post Diagnosis - Additional Tests
The following 3 tests are recommended for nearly all HCM patients. Due to the complexity of cardiac MRI it has its own page - click here to view.
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. There are new styles of monitoring including the ZioPatch and long wear event monitors which can be worn for 3 weeks or longer. In situations where the event monitor is not capturing events and there is concern a Lynx (Medtronic) implantable monitor can be used - it is tiny and can be in the body up to 3 years and removed easily.
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.
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. Cardiac catheterization in HCM are primarily used in 2 situations, pre surgery for planning and to evaluate for transplant.
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.
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.
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.
Maron, B.J. and Salberg, L. Hypertrophic Cardiomyopathy: For patients, their families and interested physicians. Blackwell Futura: 1st edition 2001,81 pages; 2nd edition 2006, 113 pages; 3rd edition pending publication 2014
Gersh, B.J., Maron, B.J., Bonow, R.O., Dearani, J.A., Fifer, M.A., Link, M.S., et al. (2011). 2011 ACCF/AHA guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation/American Heart Asociation Task Force on practice guidelines. Journal of the American College of Cardiology and Circulation, 58, e212-260.
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, ten Cate FJ, Wigle ED. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2003;42:1687-1713 and Eur Heart J 2003;24:1965-1991.