Obstructive Hypertrophic Cardiomyopathy in a Symptomatic Professional Athlete Treated With Mavacamten.

BACKGROUND

Management of left ventricular outflow tract obstruction (LVOTO) in competitive athletes with hypertrophic cardiomyopathy (HCM) is challenging, particularly when obstruction is exercise-induced and medical therapy is poorly tolerated.

CASE SUMMARY: A 28-year-old professional athlete presented with recurrent syncope. Resting imaging showed asymmetric septal hypertrophy without obstruction, but stress echocardiography revealed severe dynamic LVOTO (peak gradient: 150 mm Hg). Beta-blockers caused fatigue with persistent gradients. After shared decision-making, mavacamten was initiated. Follow-up stress imaging demonstrated complete resolution of LVOTO with preserved systolic function. The athlete returned to professional competition and remained event-free at 2 years.

DISCUSSION: Current guidelines emphasize shared decision-making for athletes with HCM. This case highlights the importance of stress imaging to unmask LVOTO and supports mavacamten as a viable alternative.

TAKE-HOME MESSAGES: Stress testing is critical in symptomatic athletes with HCM. Mavacamten may permit alleviation of LVOTO and safe return to play.