Hypertrophic Cardiomyopathy in Athletes

Sudden cardiac death (SCD) in a young person is a rare but tragic occurrence. The impact is widespread, particularly in the modern era of media coverage and visibility of social media. Hypertrophic cardiomyopathy (HCM) is reported historically as the most common cause of SCD in athletes younger than 35 years of age. A diagnosis of HCM may be challenging in athletes as pathological hypertrophy of the left ventricle may also mimic physiological left ventricular hypertrophy (LVH) in response to exercise. Differentiation of physiological LVH from HCM requires an array of clinical tools that rely on detecting subtle features of disease in a supposedly healthy person who represents the segment of society with the highest functional capacity. Most studies are based on comparisons of clinical tests between healthy unaffected athletes and sedentary individuals with HCM. However, data are emerging that report the clinical features of athletes with HCM. This article focuses on studies that help shed further light to aid the clinical differentiation of physiological LVH from HCM. This distinction is particularly important in a young person: a diagnosis of HCM has significant ramifications on participation in competitive sport, yet an erroneous diagnosis of physiological adaptation in a young athlete with HCM may subject them to an increased risk of SCD.