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The Role of Echocardiography in Hypertrophic Cardiomyopathy

Posted on November 15, 2022
Medically reviewed by
Charles Whitcomb, M.D.
Article written by
Emily Wagner, M.S.

Hypertrophic cardiomyopathy (HCM) is a heart condition that causes thickening and stiffening of the left ventricle (LV), the lower left chamber of the heart. Most people with HCM have a thickening of the wall between the two ventricles of the heart called septal hypertrophy. This makes it difficult for the heart to pump blood properly.

Echocardiography is an imaging method used to look for abnormalities in the heart to diagnose HCM. It allows cardiologists to look at the heart muscle for thickening, which can’t be seen with chest X-rays.

In hypertrophic cardiomyopathy, the walls of the left ventricle of the heart are thicker than normal. (Adobe Stock)

What Is an Echocardiogram?

An echocardiogram is a type of ultrasound that looks at your heart’s movements. It uses soundwaves that bounce off the heart and are sent back to a transducer (handheld wand), which turns them into live images. Cardiologists can use echocardiograms to diagnose issues with the chambers or valves in your heart. They can look at systolic function (how your heart pumps) and diastolic function (how it relaxes). Ultrasound technology doesn’t use radiation, unlike X-rays or CT scans.

There are two main types of echocardiograms used to look at the heart — transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). Echocardiograms are performed by cardiac sonographers who specialize in using ultrasound equipment to take pictures of the heart.

In some cases, your cardiologist may order Doppler echocardiography, which measures the direction and speed of blood flowing through your heart.

Transthoracic Echocardiogram

A TTE is the most common type of echocardiogram. This noninvasive method involved pressing a transducer against your chest to look at your heart. Cardiologists use a TTE to check how well your heart is pumping blood, to measure your heart chambers, and to check blood pressure within the heart. They’re also used to diagnose different heart conditions, such as:

  • Hypertrophic cardiomyopathy
  • Blood clots
  • Heart failure
  • Heart valve disease
  • Bulges in blood vessels, known as aneurysms

If your ribs or lungs are blocking the sonographer’s view of the heart, they may use an enhancing agent. These are tiny bubbles filled with gas that help the heart stand out in images. A small amount of enhancing agent is infused into your bloodstream through a vein.

Transesophageal Echocardiogram

When your cardiologist wants more detailed pictures of your heart, or if the sonographer couldn’t get clear pictures with a TTE, you may have a TEE. This is a more invasive method that uses an endoscope, a long thin tube with a transducer on the end of it. This tube is inserted down your esophagus via your throat to get closer to your heart.

A TEE lets cardiologists see the structures in the back of your heart, including the:

  • Thoracic aorta — The largest blood vessel found in your chest
  • Left atrium — The upper left chamber of your heart
  • Interatrial septum — The wall that separates the upper chambers of your heart

This method can also be used to diagnose heart conditions, including:

  • Blood clots
  • Aneurysms in the aorta
  • Heart valve disease, such as mitral valve disease
  • Disease in the pericardium — the sac that surrounds the heart
  • Infections in the heart, such as endocarditis

How Is Echocardiography Used in Hypertrophic Cardiomyopathy?

HCM is diagnosed when the heart muscle in the LV becomes enlarged and hardens, making it more difficult for it to pump blood. To see the structures in the heart and look for thickened walls, cardiologists use echocardiography. Different types of echocardiography are used to look for symptoms of HCM.

M-Mode Echocardiography

HCM was first seen and diagnosed using M-mode echocardiography. M-mode makes a one-dimensional image of the heart’s tissues, laying it out in a flat line. This method works well for measuring LV wall thickness. HCM is diagnosed when the LV wall is thicker than 15 millimeters.

In M-mode (one-dimensional) echocardiography, you can see the layers of the heart as if you’d cut it in half, which makes it easier to measure the thickness of the walls.


M-mode echocardiography can also help cardiologists find other abnormalities related to HCM like an enlarged left atrium and problems with the mitral valve of the heart. These issues can lead to other heart problems like atrial fibrillation, mitral regurgitation, and abnormal blood flow.

Two-Dimensional Echocardiography

Unlike M-mode echocardiography, which looks at the heart in one dimension, two-dimensional echocardiography can look at the whole heart to see if the LV is enlarged and has thickened walls.

Doppler Echocardiography

Doppler echocardiography is used to look at the blood flow through the heart. As blood cells move through, the sound waves bouncing off them change pitch, which can be measured. This method can help diagnose obstructive HCM, where blood flow may be abnormal or blocked.

Doppler echocardiography uses colors to show how blood is flowing in the heart and blood vessels. The image above is from a normal heart. (CC BY-SA 3.0/Kalumet)


What To Expect With an Echocardiogram

Getting an echocardiogram is a fairly straightforward procedure. A TTE typically takes between 40 and 60 minutes, and a TEE can take up to 90 minutes.

TTEs don’t require any preparation, and you can eat or drink as you normally do before the procedure. You’ll likely be asked to remove your shirt so the sonographer can place patches that measure your heart’s electrical activity onto your chest. This is known as an electrocardiogram (ECG), which is also used to check your heart health. The sonographer will add some gel to the end of the transducer and then place it on your skin to take images. You may be asked to hold your breath at times throughout the procedure or move into different positions lying down to get different images.

A TEE is a more invasive procedure that requires preparation. You’ll be given medications to help you relax during the procedure, so you need to have someone to drive you home. You also won’t be able to eat or drink at least six hours before your TEE.

When you arrive at the hospital or clinic, your medical team will likely have you put on a hospital gown, and then they’ll place patches for an ECG. You’ll be given a numbing spray or solution to gargle in your throat. An intravenous line will be placed in your arm to give you medication for sedation. Once you’re comfortable and relaxed, the endoscope will be placed down your throat, and the physician will take the images they need.

After your echocardiogram, your cardiologist will follow up with you on the findings. They’ll likely discuss the next steps and a management or treatment plan with you if you are given a diagnosis of HCM. Sometimes, the echocardiographic findings guide your cardiologist on what treatments you may need.

Talk With Others Who Understand

MyHeartDiseaseTeam is the social network for people with heart disease and their loved ones. On MyHeartDiseaseTeam, more than 54,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Have you had an echocardiogram to diagnose your HCM? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    All updates must be accompanied by text or a picture.
    Charles Whitcomb, M.D. has been a clinical cardiologist for over forty-five years. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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