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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

22/Thank you for joining this #CME #MedX!
To earn CME credit or view references and glossary: link.med-iq.com/7mpkl9

Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

21/Access additional HCM CME: clinical.med-iq.com/activity/hcm...

And provide helpful resources to your patients: www.med-iq.com/taking-contr...

MedIQ Clinical

clinical.med-iq.com

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

20/HCM is more common—and more treatable—than you think.
Dig deeper when symptoms don’t make sense.
You might change (or save) a life. Right time to raise awareness.
#MedEd #CardioSky

Key takeaway messages about HCM management:
• Should be considered individually
• It is a treatable disease
• Each patient is highly variable in expression, management, and clinical course
• Increased focus on HCM is leading to more medical therapies, evolution of assessment and recommendations
• There has never been a better time to treat HCM

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

19/Key Takeaways.
✅ HCM often goes undetected
✅ Symptoms may be vague
✅ Provoked testing is essential
✅ New therapies can reduce need for surgery
✅ Refer early

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

18/Jordan’s Follow-Up.
After 12 weeks on mavacamten:
• NYHA II → I
• Gradient dropped to 18 mm Hg
• “I feel like myself again.”

Timely diagnosis + therapy = life-changing outcome.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

17/Don’t Miss the “Atypical” Patient.
HCM is underdiagnosed in:
• Women
• Black patients
• Older adults

Bias and phenotype variability contribute to delays.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

16/What’s Next in HCM?
• Aficamten (next-generation myosin inhibitor): promising results in REDWOOD-HCM and SEQUOIA-HCM
• Gene therapies in early trials
• AI tools using ECG and echo data to identify undiagnosed HCM

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

15/Genetic Counseling Matters.
HCM is hereditary. MYBPC3 and MYH7 are the most common gene mutations. Counsel and screen first-degree relatives.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

14/Shared Decision Making.
Involve patients in all decisions:
• ICD
• Exercise
• Family screening
• Advanced therapies

Shared decision making improves outcomes.

Infographic that illustrates the comprehensive, multidisciplinary approach to HCM care, emphasizing shared decision making at the center with various healthcare specialties collaborating around the patient's needs.
The diagram shows a circular network with “HCM Care” at the center, surrounded by an inner gray ring labeled “Shared Decision Making.” Around this central hub are 10 blue circles representing different team members and specialties, arranged in a circular pattern: HCM Cardiologist & Team, Advanced HF Team, CV Surgical & Structural Team, Genetic Counselors & Testing, Primary Care Team, Primary Cardiologist, Lifestyle Nutrition Exercise, Research Team, Electro-physiologist, and Advanced Cardiac Imaging.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

13/Exercise Isn’t Forbidden.
Mild- to moderate-intensity aerobic activity is safe and encouraged in most HCM patients. The old “no exercise” advice is now obsolete.

The first slide summarizes key findings from the RESET-HCM study. The subtitle reads “The Randomized Exploratory Study of Exercise Training in Hypertrophic Cardiomyopathy (RESET-HCM).” The main content includes four bullet points: 136 patients with HCM; mean age, 50.4 years; Randomly assigned to 16 weeks of moderate-intensity exercise training or usual activity; Moderate-intensity exercise resulted in a significant but small increase in exercise capacity (+ 1.35 mL/kg/min) vs the usual activity group (+0.8 [95% CI, -0.62 to 0.79] mL/kg/min); P = 0.02; No adverse events (sustained ventricular arrhythmia, SCA, appropriate defibrillator shock, or death) in either group. The text “No adverse events” appears in red for emphasis.

The next slide discusses that in athletes with HCM, continuing versus stopping sports competition did not significantly affect symptom development or adverse events over a 9-year follow-up period. The main content includes bullet points: 35 athletes with HCM; mean age, 32; 33 (94%) White; 31 (88%) low risk by ESC risk score; Mean observation, 9 years; 1 SCA occurred (amateur tennis player while walking); No difference in the incidence of symptoms or events among patients who stopped or continued sport competitions (with 'stopped or continued' highlighted in red and blue, respectively).

The next slide discusses the LIVE-HCM study. This is a prospective cohort study with 1,660 patients with HCM. There were 42 centers in the US and globally, plus self enrollment. Categorize by self-reported exercise including sedentary (252), moderate (709) and vigorous (699 total with 259 competitive). The patients were followed for more than 3 years and the event rate (death plus arrhythmia was 4.6%). Patients who exercised vigorously compared to those who exercised moderately or were sedentary did not experience higher rate of death/life-threatening arrhythmias.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

12/When to Refer to HCM Centers.
Refer if:
• Symptoms refractory to medication
• Complex anatomy or ICD evaluation
• Genetic counseling needed

HCM specialty centers are associated with improved outcomes.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

11/Risk Stratification Tools.
SCD risk? Don’t guess—use the AHA/ACC calculator.
• LGE on MRI
• NSVT on Holter
• Apical aneurysm
• LV thickness ≥ 30 mm

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

10/Key trials you should know:
• EXPLORER-HCM
• VALOR-HCM
• REDWOOD-HCM
• SEQUOIA-HCM

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

9/Not All Obstruction Is Obvious.
Symptoms and borderline imaging? Dig deeper.
LVOT gradients can be dynamic.
Use provoked studies, stress echo, or MRI.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

8/Mavacamten: A Game-Changer. First-in-class cardiac myosin inhibitor:
• Reduces contractility and obstruction
• Improves symptoms and QOL

LVEF must be monitored (REMS requirement).

Flowchart that outlines the stepwise treatment approach for oHCM according to current AHA/ACC guidelines. It shows a sequential treatment approach starting with “Symptomatic patient with oHCM” at the top, followed by downward arrows connecting each step: “Avoid vasodilators and high-dose diuretics,” then “Beta blocker, verapamil, or diltiazem,” then “If symptoms persist.” From this point, three treatment options branch out: Myosin inhibitor, Disopyramide, and SRT. A side note indicates “Mavacamten: FDA approved for symptomatic NYHA class II-III oHCM.”

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

7/At #AHA2024, the VALOR-HCM Extension study showed:
• Sustained reduction in LVOT gradient
• Improved symptoms
• Reduced septal reduction procedures

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

6/Jordan’s Diagnosis. Repeat echo:
• IVS = 17 mm
• SAM of MV
• Resting gradient = 12 mm Hg
• Provoked = 68 mm Hg

Diagnosis: oHCM
Provocative testing made the difference.

Flowchart that illustrates the systematic clinical approach for evaluating patients suspected of having HCM, including diagnostic testing and genetic screening pathways.

Three parallel initial assessments: Personal history: Symptoms, Physical exam, and Family history: HCM diagnosis, sudden death. These lead to “Testing,” which branches into three diagnostic tools: ECG, Echo, and CMR. These tests lead to “Identification of HCM prototype (LVH).” From family history, the pathway also leads to “Identify phenocopies” and then “Genetic testing.” The genetic testing branch notes “Pathogenic sarcomere mutation (30% of patients)” and leads to “Cascade testing of family members.” This final step branches into two outcomes: “G+/P+” and “G+/P-,” with the latter leading to “Surveillance for LVH development.”

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

5/When to Suspect HCM. Red flags:
• Dyspnea, syncope, or presyncope
• Systolic murmur increasing with Valsalva
• Family history of sudden cardiac death
• Wall thickness ≥ 15 mm (≥ 13 mm with family history)

Medical infographic lists common symptoms: dyspnea, fatigue, palpitations, chest pain, and presyncope and syncope. HCM may be challenging to identify and monitor due to the dynamic nature of symptoms (patients have “good” and “bad” days); as symptoms gradually and subtly progress (ie, “symptom creep”), patients may adapt their lifestyle to their new limitations (adapting to the “new normal”). Function and overall well-being can decline over time.

Important to delve deeper when a patient presents with common, persistent symptoms (especially dyspnea) with exertion
Use subjective questions for symptoms and function and correlate with objective assessments of symptoms, such as NYHA classification, and ECHO results
For subjective assessment of symptoms, a simplified but structured questionnaire is useful
Consider creating a simplified questionnaire or use KCCQ for guidance
Use open-ended questions that encourage patients to describe their functional capacity and any lifestyle modifications they may have made. Subtle functional limitations may be uncovered when asked about daily activities and comparing current to previous function. Examples of questions to capture common HCM symptoms and dysfunction:
Were you active as a child? What was your favorite sport? Are there activities that you
used to enjoy that you can no longer pursue?
Do your symptoms worsen after any activity? After a heavy meal? Or on a hot day?

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

4/Echo Alone Isn’t Enough.
A resting echo may miss dynamic LVOT obstruction. Valsalva or exercise echo should be used to unmask gradients; ~30% of “nonobstructive” HCM patients have provoked obstruction.

Key echocardiographic criteria and guidelines for diagnosing HCM. Per the 2024 AHA/ACC guideline for HCM, diagnosis is defined by a maximal LV wall thickness of ≥ 15 mm, or 13-14 mm in the presence of family history or in conjunction with a positive genetic test. Echocardiography remains the gold standard for noninvasive assessment of outflow tract obstruction in HCM.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

3/Missed Diagnoses Are Common.
HCM affects ~1 in 200-500 people, but many go undiagnosed for up to 5 years. HCM is especially underrecognized in women and Black individuals. Symptoms are often misattributed to anxiety, asthma, aging, and deconditioning.

World map; red indicates global epidemiologic data about HCM. Distribution spans 122 countries accounting for 88% of world population; prevalence is 1 case per 200-500 persons, and estimated 20 million people affected worldwide.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

2/Time for a case! Meet Jordan, 42 years old with fatigue and dyspnea on exertion; was told it’s “asthma.” Echo 3 years ago showed “borderline LVH.” No follow-up. PCP orders another echo.
Let’s walk through what was missed—and why it matters.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 8d

1/22 In this #CME #MedX, Matthew W. Martinez, MD, FACC, provides guidance for managing HCM, from symptoms to diagnosis and treatment, and explores when oHCM may be hiding in plain sight.

Participate for credit: link.med-iq.com/7mpkl9

Supported by an educational grant from Bristol Myers Squibb.

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Med-IQ cardiology @med-iqcardiology.bsky.social · 9d

Marcus Anthony Urey, MD presented data on GI AEs in the HELIOS-B trial

#HFSA2025
#MedIQHFSA2025

Med-IQ cardiology @med-iqcardiology.bsky.social · 9d

Highlights the time sensitive nature of ATTR-CM diagnosis to treatment.

And we need to understand if there is a hemodynamic effect mediating some of the observed results - need to study this more

The paper with more details is in now in JACC Journals
jacc.org/doi/10.1016/...

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Med-IQ cardiology @med-iqcardiology.bsky.social · 9d

We presented exploratory data from ATTRibute-CM looking at all events - CVM and recurrent CVH - which show early and sustained effect of acoramidis throughout the study.

#HFSA2025
#MedIQHFSA2025

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