Hypertrophic cardiomyopathy in the aged

Although usually considered a disease of young or middle-aged adults, hypertrophic cardiomyopathy is not infrequently seen in older patients as well. Twenty of 23 cases of hypertrophic cardiomyopathy seen in the past 2 1 2 years at our institution have been in patients whose average age was 65 years, and who ranged up to 76 years. Sixteen of these had evidence of an obstructive component at cardiac catheterization or echocardiography. Symptoms and signs were similar to those described for the younger patients in the literature, but were often attributed to other causes, including valvular aortic stenosis, arteriosclerotic or hypertensive heart disease, or cerebrovascular disease. Left ventricular hypertrophy was more consistently present on ECG than on x-ray. The not-infrequent occurrence of hypertrophic cardiomyopathy in older patients, predominantly females, indicates that the natural history of this disease includes a group who suffer few or no symptoms until late in life. Clinical management of younger patients with this diagnosis should be considered in light of this more favorable possible course.