What is an appropriate initial test for evaluating suspected hypertrophic cardiomyopathy?

An echocardiogram is the most appropriate initial test for evaluating suspected hypertrophic cardiomyopathy. This imaging modality provides critical information about the structure and function of the heart, particularly in identifying the hypertrophy of the ventricular walls, which is a hallmark of this condition. The echocardiogram can show abnormalities such as asymmetric septal hypertrophy, which is commonly seen in hypertrophic cardiomyopathy and can help assess the degree of left ventricular outflow obstruction, if present.

Additionally, the echocardiogram can provide further evaluation of wall motion, valve function, and overall cardiac function. Given that hypertrophic cardiomyopathy can lead to significant implications for patient management, including risk stratification for arrhythmias and sudden cardiac death, the echocardiogram serves as a fundamental tool in not just confirming the diagnosis but also in guiding further management and follow-up.

In contrast, while a stress test can assess functional capacity and potentially reveal exercise-induced symptoms, it is not the first-line diagnostic tool for structural heart conditions like hypertrophic cardiomyopathy. A CT scan is primarily used when additional anatomic detail is needed, and electrophysiology studies are usually reserved for assessing arrhythmias rather than making an initial diagnosis of hypertrophic cardiomyopathy