30% never knew: Doctor reveals alarming link between hypertrophic cardiomyopathy and sudden cardiac death

A leading cardiologist has raised alarm over a silent but deadly heart condition, hypertrophic cardiomyopathy (HCM), after revealing that nearly 30% of patients experience sudden cardiac death as their very first symptom. The condition, which often affects seemingly healthy young adults and athletes, remains dangerously underdiagnosed across India and worldwide.Dr Shailesh Singh, an interventional cardiologist took to X (formerly Twitter) to reveal about hypertrophic cardiomyopathy. “You’re 33. You hit the gym six days a week. You’ve been training for five years. No symptoms. No chest pain. No dizziness. Your resting heart rate is 52—athlete-level fitness. You don’t know that your ventricular septum is 18mm thick. Normal is under 12mm. You have hypertrophic cardiomyopathy. Your father’s brother died suddenly at 28 during a football game. Your family thought it was a freak accident. It wasn’t,” he begins.“Standard pre-gym screening doesn’t catch this. A physical exam won’t detect it. Your blood pressure is normal. Your heart sounds are normal. Even an ECG might miss it—ECGs only identify HCM in 50-70% of cases. The gold standard is cardiac MRI. But ordering an MRI for every gym member isn’t feasible or cost-effective. The healthcare system doesn’t screen asymptomatic young adults for genetic cardiomyopathies unless family history raises flags. This is the screening gap. The conditions that kill young athletes stay silent until they don’t,” he describes.

So what’s the solution?

“Know your family history. If sudden death runs in your family—particularly in relatives under 50—you need evaluation before intense training. That means ECG, echocardiogram, possibly cardiac MRI,” Dr Singh recommends. “Pay attention to symptoms during exertion. Chest pressure isn’t normal. Sustained palpitations after stopping exercise aren’t normal. Syncope or near-syncope during lifting isn’t normal. These aren’t signs of pushing hard—they’re warnings your heart is electrically unstable,” he adds.

Globally, the prevalence of HCM is estimated to be 1 in 500 people

But these numbers may be even higher in regions with limited cardiac awareness. Despite being detectable through basic imaging, it often slips through the cracks due to lack of routine testing and low suspicion among primary care doctors. Hypertrophic cardiomyopathy doesn’t discriminate, it can affect anyone, regardless of fitness level, gender, or lifestyle. The tragedy lies not in its existence but in its invisibility. With early diagnosis, lifestyle adjustments, and medical management, most patients can live long, healthy lives.