Hypertrophic Cardiomyopathy in Pregnancy

Case Report

J Fam Med. 2020; 7(6): 1215.

Hypertrophic Cardiomyopathy in Pregnancy

Punithavathy S¹*, Chia YC²

¹Department of Health & Medical Sciences, Lakeside Campus, Malaysia

²Department of Primary Care Medicine, University of Malaya, Malaysia

*Corresponding author: Punithavathy S, Department of Health & Medical Sciences, Lakeside Campus, Malaysia

Received: May 28, 2020; Accepted: October 09, 2020; Published: October 16, 2020


Hypertrophic Cardiomyopathy (HOCM) is a genetic cardiac disease. It is not commonly seen at the primary care clinic. HOCM is well tolerated in pregnancy. However, sudden death is a recognized complication during pregnancy especially in patients with severe outflow tract obstruction. This case illustrates the case of a patient who initially presented with history of being amenorrhoeic for the past four months. During the examination, a systolic murmur was identified incidentally, and the patient was further worked up. She was diagnosed with HOCM. Although she was seen by various doctors throughout her life, the diagnosis was never made. Its variable presentation and clinical course may cause a delayed or missed diagnosis of HOCM. It is hoped that this case study will illustrate the importance of diagnosing and managing patients with HOCM appropriately.

Case Report

Miss NF is a single, 30-year-old lady who was referred to the primary care clinic for the determination of the Period Of Amenorrhea (POA) and Estimated Date Of Delivery (EDD) of her pregnancy. Miss NF had amenorrhea for the last 5 months. She was unsure of her Last Menstrual Period (LMP) as her menstrual cycle always been irregular. She only began suspecting that something was amiss when she felt sudden movements in her abdomen for one week prior to the presentation to the clinic. She denied feeling any symptoms of pregnancy in the initial stages.

At the clinic, a Urine Pregnancy Test (UPT) confirmed her pregnancy. The patient had no known medical illness. She had never been hospitalized before nor had any surgical procedure in the past. This was my patient’s first pregnancy and it was unplanned. She had been sexually active since the last 1 year with her only partner (boyfriend). She had never used any form of contraception. There was no history of any medical illness in the family. She neither smokes nor drinks alcohol.

On examination, she was pink, and not in respiratory distress. Her BP was 100/60 mmHg and her pulse rate was 74 beats per minute, regular rhythm and good volume. There was no pedal edema. Her cardiovascular examination revealed a loud systolic murmur along the left sternal edge (Grade III). There was no radiation to the neck or axilla. Apex beat was located in the mid clavicular line of the 5th intercostal space. There was no thrill palpable. The air entry was equal on bilateral lung field. There were no crepitations. On palpation, the abdomen was soft and non-tender. The uterus was palpable at about 18 weeks and the fetal parts were palpable.

In view of the newly diagnosed heart murmur, an echocardiogram was done, and it was noted that the patient had apical Hypertrophic Obstructive Cardiomyopathy (HOCM). Her ejection fraction was noted to be 64%. Her left ventricle was noted to be normal in size and of normal systolic function. The left ventricular wall motion was normal and pulmonary artery pressure was noted to be 29 mmHg. She was started on metoprolol 25 mg bd and followed up closely at the antenatal clinic. Patient ‘s infective screening (HIV Ag/Ab Combo), fasting and2 hours post glucose readings, hemoglobin levels (12.8g/ dl) and her renal profile were within normal parameters. During the fetal ultrasound, fetal heart activity was detected, and other fetal parameters were corresponded with her REDD.

She had a Caesarean section at 38 weeks POA as there was poor progress of labor and CTG revealed fetal distress. The caesarean section was uneventful. The patient was in stable condition and her girl baby was healthy and weighed 3.53kg.


Cardiovascular diseases are seen in 0.5-4% of pregnant women.1 The most common disorders are rheumatic valvular disease, congenital heart disease and cardiomyopathy [1].

Hypertrophic cardiomyopathy is a relatively common genetic cardiac disease with a ratio of 1:500 in general population [2]. It is an autosomal dominant disease but 50% of cases are sporadic [3]. it is due to mutations of the cardiac sarcomere proteins. HOCM may present at any age.

Clinical diagnosis is by electrocardiography whereby there is identification of otherwise unexplained left ventricular wall thickening of more than 15mm in the presence of non-dilated cavity [4]. Anteroseptal hypertrophy is mostly involved whereas patterns such as concentric hypertrophy or pure apical involvement are less common [4].

Left ventricular morphology in Hypertrophic Obstructive Cardiomyopathy (HOCM). Figure 1 cited from the study of Johan MB et .al.2018 (Figure 1).

Citation:Punithavathy S, Chia YC. Hypertrophic Cardiomyopathy in Pregnancy. J Fam Med. 2020; 7(6): 1215.