HCM is a relatively common inherited cardiac disease with a prevalence of around 1 in 500 commonly presenting in adolescents. It is generally associated with restricted out flow from the ventricles commonly the left. It is often asymptomatic but may present as severe breathlessness at exercise or unexplained fainting, a heart murmur or ECG abnormality. Annual mortality is around 1%. Investigation includes ECG , echocardiogram, cardiac MRI. Treatment involves lifestyle change, avoiding high intensity exercise and using medications like verapamil or beta blockers for rate control.