The lack of awareness that hypertrophic cardiomyopathy is indeed seen in older patients is widespread. The resulting low index of suspicion, coupled with the fact that the clinical presentation of this condition closely resembles the presentations of several common disorders of the elderly, can lead to misdiagnosis and inappropriate and possibly harmful treatment. When an elderly patient presents with dyspnea, angina, or syncope, the presence of a systolic murmur that changes in intensity with appropriate diagnostic maneuvers should prompt consideration of hypertrophic cardiomyopathy, which can be easily verified (or excluded) by echocardiography. This approach minimizes diagnostic and therapeutic errors.