What is observed on echocardiography in hypertrophic cardiomyopathy?

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On echocardiography, hypertrophic cardiomyopathy is seen as asymmetric thickening of the heart muscle, most prominently in the interventricular septum, with the left ventricular walls being markedly hypertrophied and the cavity often relatively small. This thickened septum is what creates the potential for dynamic obstruction of the outflow tract, especially when the mitral valve moves toward the septum during systole (systolic anterior motion). A key point is that systolic function is usually preserved or even hyperdynamic in classic HCM; the ejection fraction is not characteristically reduced. So the hallmark finding is the hypertrophied septum and left ventricular walls, with a normal or elevated ejection fraction, rather than a small ejection fraction. Pericardial effusion or a dilated ventricle with reduced EF would point to other conditions, not typical HCM.