{"id":63387,"date":"2024-05-01T07:52:49","date_gmt":"2024-05-01T02:22:49","guid":{"rendered":"https:\/\/johnsonfrancis.org\/professional\/?p=63387"},"modified":"2024-05-01T10:52:31","modified_gmt":"2024-05-01T05:22:31","slug":"hypertrophic-cardiomyopathy","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/","title":{"rendered":"Hypertrophic Cardiomyopathy"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/8ugkVklg6Pw?si=49pXDahvHOhpaaiQ\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><br \/>\nHypertrophic cardiomyopathy is a genetic disorder with a guarded prognosis which occurs in about 1:500 individuals.<br \/>\nIt is an autosomal dominant disorder with variable penetrance with either a defect in sarcomeric protein genes which encode for myosin heavy chain, actin or tropomyosin or due to abnormal myocardial Ca++ kinetics which increase intracellular Ca++, causing hypertrophy and cellular disarray.<br \/>\nEchocardiography is the sheet anchor of diagnosis of HCM and other modalities are complementary.<br \/>\nMYH7 mutation in the gene which encodes for beta myosin heavy chain, located on chromosome 14 is found in about 15-25% of cases of HCM. MYBPC3 which encodes for cardiac myosin binding protein C is abnormal in another 15-25% cases.<br \/>\nBesides these several other mutations have been described, some of which are available commercially for testing.<br \/>\nThere are several phenocopies of HCM, caused by other disorders like Barth syndrome, Danon\u2019s syndrome, Pompe\u2019s disease, Fabry\u2019s disease, Friedreich\u2019s ataxia and Noonan\u2019s syndrome. Genetic markers for several of these disorders are also available commercially.<br \/>\nSigmoidal HCM which is about 40-50% has about 10% positivity for myofilament gene. Reverse curve HCM occurs in 30-40% cases and has a myofilament gene in 80% of them. Apical HCM and neutral HCM (with symmetric hypertrophy) contributes 10% each and has 30-40% positivity of myofilament gene.<br \/>\nThe most common symptom of hypertrophic cardiomyopathy is dyspnoea which occurs in 90% of cases and is due to elevated left ventricular diastolic pressures as a consequence of the diastolic dysfunction. Angina is another common symptom due the hypertrophy which causes a coronary supply demand mismatch<br \/>\nSymptoms of HCM include syncope\/near syncope, which could be precipitated by exertion, hypovolemia, rapid standing, Valsalva manoeuvre, diuretics, vasodilators or arrhythmia. Palpitations can be felt if there are arrhythmias.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>Physical signs in HCM<\/strong><\/span><\/p>\n<p>The carotid pulse is jerky and may have dual peaks. But the second peak is often appreciated only in a pulse tracing rather than on palpation, because it is somewhat rounded. Jugular venous pulse may show a prominent a wave.<br \/>\nDouble or triple apical impulses can be felt in HCM. In case of triple impulse, it is one diastolic (due to forceful atrial contraction) and two systolic impulses (due to mid systolic obstruction).<br \/>\nParadoxical splitting of second heart sound can occur due to the left ventricular outflow tract obstruction. A third heart sound occurs when the left ventricle decompensates in late stages of HCM.<br \/>\nA prominent fourth heart sound is usual in HCM due to the diastolic dysfunction which causes forceful atrial contraction. Dynamic auscultatory features are important in the diagnosis of HCM.<br \/>\nThe systolic ejection murmur increases with a decreased preload as in volume depletion, nitrate therapy or standing or a decreased afterload with vasodilators. The murmur decreases with an increase in preload or afterload (isometric hand grip).<br \/>\nThe post ectopic increase in the murmur is a hallmark of hypertrophic obstructive cardiomyopathy, which differentiates it clinically from mitral valve prolapse.<\/p>\n<p><strong><span style=\"color: #0000ff;\">ECG changes in HCM<\/span><\/strong><\/p>\n<p>ST-T wave abnormalities are common, with ST segment depression and T wave inversion predominating. Left ventricular hypertrophy, left atrial enlargement, QRS axis deviation (left more than right), conduction abnormalities like increased P-R interval and bundle branch block may be noted.<br \/>\nAtrial fibrillation if present indicates poor prognosis as hemodynamic decompensation occurs due to loss of atrial booster action which is vital for the filling of a hypertrophied left ventricle with severe diastolic dysfunction.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Echocardiography in HCM<\/span><\/strong><\/p>\n<p>Important echocardiographic features include mitral regurgitation and left ventricular outflow tract obstruction. The ejection fraction is high to normal, except in late decompensated stage. Small left ventricular cavity and left atrial enlargement are other features.<br \/>\nSeptal thickness is often 4-6 mm more than normal. Asymmetric septal hypertrophy with absolute thickness more than 15 mm, septal\/posterior wall ratio more than 1.3 in normotensives and more than 1.5 in hypertensives are some of the features.<br \/>\nRarely normal septal thickness can occur in genotype +ve cases, especially in cardiac troponin T mutations.<br \/>\nNormal echo earlier in life can occur in cardiac myosin binding protein C mutation, which mandates repeat echo evaluation after five years. Apical hypertrophy can produce an ace of spades configuration of the left ventricular cavity.<br \/>\nWhile assessing the severity of HCM, maximal wall thickness in multiple segments, length of septal hypertrophy, extension to apical segments and involvement of papillary muscles \u2013 anterior displacement\/direct insertion into mitral valve have all to be looked into.<br \/>\nEchocardiogram showing thickened interventricular septum and mitral regurgitation in HCM.<\/p>\n<p><strong><span style=\"color: #0000ff;\">SAM in HCM<\/span><\/strong><\/p>\n<p>Systolic anterior movement of mitral valve occurs in 30 \u2013 60%, but it is not specific. SAM causes LVOTO, increased ejection time and a decreased stroke volume, as well as mitral regurgitation due to poor coaptation of the leaflets.<br \/>\nSeverity of SAM can be quantified by SAM septal contact time. In mild cases it is less than 10% and in severe cases it is more than 30% of the systole.<\/p>\n<p><strong><span style=\"color: #0000ff;\">LVOTO in HCM<\/span><\/strong><\/p>\n<p>Peak gradient more than 30 mm Hg predicts SCD in HCM, though the gradients may be much higher in some cases. LVOTO is due to septal hypertrophy, SAM, and anterior displacement of mitral valve apparatus.<br \/>\nDoppler echo showing LVOT gradient in HCM.<br \/>\nMid cavity obstruction in HCM is associated with apical aneurysm, systemic embolism, and arrhythmias. Cases are on record, in which ablation of the fourth septal artery has been done to ameliorate the obstruction in mid cavity obstruction.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Dynamic gradient in HCM<\/span><\/strong><\/p>\n<p>Dynamic gradient occurs in 25-30% and depends on blood volume\/contractile state. Dynamic gradient may be sought by glyceryl trinitrate, Valsalva manoeuvre, standing position or even symptom limited exercise. Obstruction may occur during recovery and post exercise monitoring of gradient is mandatory.<\/p>\n<p><strong><span style=\"color: #0000ff;\">False negative echo in HCM<\/span><\/strong><\/p>\n<p>Distal or apical hypertrophy may be missed and is best estimated on sequential short axis views. Wall thickness may be normal in children and adolescents, cardiac troponin T mutations as well as in end stage HCM with dilated LV.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>False positive echo in HCM<\/strong><\/span><\/p>\n<p>Oblique cut\/foreshortened views and sigmoid septum in elderly can cause false positive diagnosis of HCM. Thin posterior wall in inferior wall myocardial infarction causing abnormal septal to posterior wall ratio can also cause suspicion of ASH. LVOT gradients in hyperdynamic states may also be mistook for LVOT obstruction in HCM.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Differential diagnosis of HCM<\/span><\/strong><\/p>\n<p>Differential diagnosis is not just by echo, but there is vital role for history and clinical examination. Hypertensive heart disease is an important differential diagnosis, but SAM is rare in this situation and there is evidence of greater diastolic dysfunction in HCM.<br \/>\nAthlete\u2019s heart is another entity with hypertrophy which may be confused with HCM. Normal\/supernormal tissue Doppler velocities in athlete\u2019s heart contrast with impaired velocities in HCM. LV cavity dilatation is seen in athlete\u2019s heart.<br \/>\nCardiac amyloid is manifested with thickened interatrial septum, increased myocardial echogenicity and thickening of valve leaflets.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Cardiac cath<\/span><\/strong><\/p>\n<p>Cardiac cath has a limited role in the diagnosis of HCM in this era of echocardiography. Degree of outflow obstruction can be documented along with the classical Brockenbrough-Braunwald-Morrow sign. The sign is an increased LVOT gradient after a ventricular premature complex.<br \/>\nEvaluation of diastolic characteristics of LV and LV and coronary anatomy evaluation are other diagnostic uses of cath in HCM. The role of cath now a days is mostly for septal ablation.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Holter monitoring<\/span><\/strong><\/p>\n<p>Holter monitoring is useful to document nonsustained atrial\/ventricular arrhythmias which may not be obvious clinically.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Contrast enhanced magnetic resonance imaging<\/span><\/strong><\/p>\n<p>Delayed enhancement on contrast enhanced MRI is useful in documenting fibrosis in HCM, which is a predictor of systolic dysfunction and has a relation to heart failure symptoms.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hypertrophic cardiomyopathy is a genetic disorder with a guarded prognosis which occurs in about 1:500 individuals. It is an autosomal dominant disorder with variable penetrance with either a defect in sarcomeric protein genes which encode for myosin heavy chain, actin or tropomyosin or due to abnormal myocardial Ca++ kinetics which increase intracellular Ca++, causing hypertrophy [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":63389,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-63387","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders\" \/>\n<meta property=\"og:description\" content=\"Hypertrophic cardiomyopathy is a genetic disorder with a guarded prognosis which occurs in about 1:500 individuals. It is an autosomal dominant disorder with variable penetrance with either a defect in sarcomeric protein genes which encode for myosin heavy chain, actin or tropomyosin or due to abnormal myocardial Ca++ kinetics which increase intracellular Ca++, causing hypertrophy [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2024-05-01T02:22:49+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-01T05:22:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1203\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Hypertrophic Cardiomyopathy\",\"datePublished\":\"2024-05-01T02:22:49+00:00\",\"dateModified\":\"2024-05-01T05:22:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/\"},\"wordCount\":1254,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2024\\\/05\\\/Hypertrophic-Cardiomyopathy.jpg\",\"articleSection\":[\"General Cardiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/\",\"name\":\"Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2024\\\/05\\\/Hypertrophic-Cardiomyopathy.jpg\",\"datePublished\":\"2024-05-01T02:22:49+00:00\",\"dateModified\":\"2024-05-01T05:22:31+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#primaryimage\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2024\\\/05\\\/Hypertrophic-Cardiomyopathy.jpg\",\"contentUrl\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/wp-content\\\/uploads\\\/2024\\\/05\\\/Hypertrophic-Cardiomyopathy.jpg\",\"width\":1203,\"height\":675},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/hypertrophic-cardiomyopathy\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Hypertrophic Cardiomyopathy\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#website\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/\",\"name\":\"All About Cardiovascular System and Disorders\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\",\"name\":\"Johnson Francis\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\",\"caption\":\"Johnson Francis\"},\"logo\":{\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g\"},\"description\":\"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/author\\\/jf\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/","og_locale":"en_US","og_type":"article","og_title":"Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders","og_description":"Hypertrophic cardiomyopathy is a genetic disorder with a guarded prognosis which occurs in about 1:500 individuals. It is an autosomal dominant disorder with variable penetrance with either a defect in sarcomeric protein genes which encode for myosin heavy chain, actin or tropomyosin or due to abnormal myocardial Ca++ kinetics which increase intracellular Ca++, causing hypertrophy [&hellip;]","og_url":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/","og_site_name":"All About Cardiovascular System and Disorders","article_published_time":"2024-05-01T02:22:49+00:00","article_modified_time":"2024-05-01T05:22:31+00:00","og_image":[{"width":1203,"height":675,"url":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg","type":"image\/jpeg"}],"author":"Johnson Francis","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Johnson Francis","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#article","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/"},"author":{"name":"Johnson Francis","@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"headline":"Hypertrophic Cardiomyopathy","datePublished":"2024-05-01T02:22:49+00:00","dateModified":"2024-05-01T05:22:31+00:00","mainEntityOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/"},"wordCount":1254,"publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#primaryimage"},"thumbnailUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg","articleSection":["General Cardiology"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/","url":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/","name":"Hypertrophic Cardiomyopathy - All About Cardiovascular System and Disorders","isPartOf":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#website"},"primaryImageOfPage":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#primaryimage"},"image":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#primaryimage"},"thumbnailUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg","datePublished":"2024-05-01T02:22:49+00:00","dateModified":"2024-05-01T05:22:31+00:00","breadcrumb":{"@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#primaryimage","url":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg","contentUrl":"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2024\/05\/Hypertrophic-Cardiomyopathy.jpg","width":1203,"height":675},{"@type":"BreadcrumbList","@id":"https:\/\/johnsonfrancis.org\/professional\/hypertrophic-cardiomyopathy\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/johnsonfrancis.org\/professional\/"},{"@type":"ListItem","position":2,"name":"Hypertrophic Cardiomyopathy"}]},{"@type":"WebSite","@id":"https:\/\/johnsonfrancis.org\/professional\/#website","url":"https:\/\/johnsonfrancis.org\/professional\/","name":"All About Cardiovascular System and Disorders","description":"","publisher":{"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/johnsonfrancis.org\/professional\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/johnsonfrancis.org\/professional\/#\/schema\/person\/5441d907049b914770f4bd98fb57feec","name":"Johnson Francis","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g","caption":"Johnson Francis"},"logo":{"@id":"https:\/\/secure.gravatar.com\/avatar\/80861b82c3f559be9e413245c5643b6c483c93495507facfe32cf96ccd8bcffd?s=96&d=mm&r=g"},"description":"Former Professor of Cardiology, Calicut Govt. Medical Kozhikode, Kerala, India. Editor-in-Chief, BMH Medical Journal","url":"https:\/\/johnsonfrancis.org\/professional\/author\/jf\/"}]}},"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/63387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/comments?post=63387"}],"version-history":[{"count":2,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/63387\/revisions"}],"predecessor-version":[{"id":63391,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/posts\/63387\/revisions\/63391"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media\/63389"}],"wp:attachment":[{"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/media?parent=63387"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/categories?post=63387"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/johnsonfrancis.org\/professional\/wp-json\/wp\/v2\/tags?post=63387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}