ECG of the Week - 24th August 2015 - Interpretation

This ECG is from a 70 year old patient who presented to the Emergency Department complaining of progressive cough and intermittent fever. She has an extensive medical history but is unable to provide you with specific details other than she sees a cardiologist.
Check out the comments on our original post here.

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Rate:

• 66 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (~180ms)
• QRS - Normal (80-100ms)
• QT - 480ms

Segments:

• ST depression leads I, V2-6
• Subtle ST elevation lead V1

Additional:

• High precordial R wave voltages
• Deep T wave inversion leads V2-3
• Global T wave inversion - all leads except aVR

Interpretation:

• Apical Hypertrophic Cardiomyopathy
• Deep T wave inversion, high R wave voltages, QT prolongation

What happened ?

This patient had known hypertrophic apical cardiomyopathy with diastolic dysfunction but preserved systolic function.

There is a nice review of the ECG features that can be seen in apical hypertrophic cardiomyopathy here:

• JE Madias. Electrocardiogram in apical hypertrophic cardiomyopathy with a speculation as to the mechanism of its features.Netherlands Heart Journal June 2013, Volume 21, Issue 6, pp 268-271.

References / Further Reading

Life in the Fast Lane

• Hypertrophic Cardiomyopathy

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.