Distinguishing hypertrophic cardiomyopathy (HCM) from its photocopies—such as cardiac amyloidosis, hypertensive left ventricular hypertrophy (LVH), and Fabry disease—is critical for accurate diagnosis and appropriate management. Echocardiographic features help differentiate these conditions; for example, cardiac amyloidosis often presents with a speckled myocardial texture, biatrial enlargement, and impaired longitudinal strain with apical sparing. Hypertensive LVH typically shows more concentric thickening with preserved myocardial strain, while Fabry disease may exhibit concentric LV thickening with posterior wall involvement and reduced basal strain. Advanced imaging techniques like strain echocardiography and contrast-enhanced modalities can further aid in distinguishing HCM from its mimics.

For patients with confirmed HCM who are on medication, echocardiography plays a vital role in monitoring treatment effects and disease progression. Beta-blockers and calcium channel blockers, commonly prescribed to manage symptoms and reduce outflow obstruction, may impact systolic and diastolic function, requiring serial echocardiographic assessments. Doppler studies help evaluate changes in LVOT gradients and diastolic function in response to therapy. Additionally, echocardiography can detect potential side effects of medications, such as worsening diastolic dysfunction or drug-induced bradycardia, ensuring optimal treatment adjustments.