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SUMMARY Hypertrophic cardiomyopathy is a disease of cardiac muscle that is often genetically transmitted as. an autosomal dominant trait and is characterized by a wide variety of patterns of left ventricular hypertrophy that may be identified with wide-angle, two-dimensional echocardiography. To determine the degree to which left ventricular morphology is similar in related patients with hypertrophic cardiomyopathy, 40 index cases with this disease and 66 of their affected first-degree relatives were studied by twodimensional echocardiography.A diverse variety of patterns of distribution of left ventricular hypertrophy were identified in the study group. In 48% of the patients, hypertrophy involved both the ventricular septum and anterolateral left ventricular free wall. Twenty percent of the patients showed hypertrophy involving regions of the left ventricle other than the basal anterior ventricular septum; hence, hypertrophic cardiomyopathy could not be diagnosed from M-mode echocardiograms, and two-dimensional echocardiography was required. In the remaining patients, hypertrophy either was confined to the anterior portion of the ventricular septum or involved the entire septum but not the free wall.