Aortic Stenosis vs Hypertrophic Cardiomyopathy
Aortic Stenosis and Hypertrophic Cardiomyopathy are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Aortic Stenosis vs Hypertrophic Cardiomyopathy at a glance
- Aortic Stenosis: Obstruction to LV outflow; classic SAD triad (Syncope, Angina, Dyspnea) signals need for AVR.
- Hypertrophic Cardiomyopathy: Genetic LVH (often asymmetric septal) with dynamic LVOT obstruction — leading cause of SCD in young athletes.
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Side-by-side comparison
| Feature | Aortic Stenosis | Hypertrophic Cardiomyopathy |
|---|---|---|
| At a glance | Obstruction to LV outflow; classic SAD triad (Syncope, Angina, Dyspnea) signals need for AVR. | Genetic LVH (often asymmetric septal) with dynamic LVOT obstruction — leading cause of SCD in young athletes. |
| Classic presentation | Crescendo-decrescendo systolic ejection murmur at RUSB radiating to carotids, pulsus parvus et tardus, late-peaking murmur in severe disease.; Classic SAD… | Often asymptomatic; HCM detected on screening or after sudden death of a family member; Exertional dyspnea, fatigue (most common symptom); Anginal chest pain;… |
| Workup / key labs | Standard CV labs: lipid panel, A1c, BMP, BNP; Pre-operative workup if AVR planned | Adult: maximum LV wall thickness ≥15 mm unexplained by loading conditions, or ≥13 mm with affected family member or positive genetic testing. LVOT gradient… |
| Imaging | ECG: LVH with strain (left precordial T-wave inversions), left atrial enlargement, occasionally LBBB or AV block from septal calcification; CXR: cardiomegaly… | Transthoracic echo — diagnostic; document septal thickness, LVOT gradient at rest and with provocation (Valsalva, exercise), SAM, MR; Cardiac MRI with late… |
| First-line treatment | Asymptomatic AS — no proven benefit from medical therapy to slow progression; Treat concomitant HTN cautiously (avoid afterload reduction that worsens output… | Avoid dehydration, alcohol, sudden standing, and intense competitive athletics (per 2020 ACC/AHA — shared decision-making for participation); Symptomatic… |
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