Mechanisms and Medical Management of Exercise Intolerance in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is an inherited disorder of cardiac sarcomeric proteins characterised by the presence of myocardial hypertrophy in the absence of abnormal loading conditions. Individuals with HCM can remain asymptomatic throughout their lives but many experience chest pain, symptoms of heart failure, syncope and sudden ventricular arrhythmias. Cardiopulmonary exercise testing is an important part of the assessment of patients with HCM who often have reduced peak oxygen consumption and a lower anaerobic threshold compared with healthy age-matched controls. This review will focus on mechanisms of exercise limitation, which are complex and multifactorial, and the options for medical management.