Wednesday, 14 September 2016

ECG of the Week - 12th September 2016 - Interpretation

The following ECG is from a 43 yr old male who was referred from his GP due to concerns over an abnormal ECG. He presented with several months of exertional dysponea, chest pain and dizziness. He was asymptomatic at GP and Emergency Department presentation.



Click to enlarge


Rate:
  • 84 bpm
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (110ms)
  • QT - 400ms (QTc Bazette 435 ms)
Segments:

  • ST depression leads I, II, V4-6

Additional:

  • Deep T wave inversion leads I, II, aVL, aVF, V3-6
  • QRS voltages in infero-lateral leads appear high without meeting LVH criteria

Interpretation:

  • Clinical history and ECG features most concerning for cardiomyopathy
  • ECG features most likely suggest apical hypertrophic cardiomyopathy (aka Yamaguchi syndrome) given the deep T wave inversion in the lateral and inferior leads.


What happened ?

He was admitted under cardiology for investigation.
Angiogram showed only 30% stenosis of the proximal circumflex complicated by contrast allergy.
ECHO showed:

  • Normal LV size with akinesis of the paical cap.
  • Asymmetrical hypertrophy of LV basal walls and apex
  • Small apical aneurysm
  • Preserved systolic function
  • Increased LV wall thickness and prominent apical thickening
  • Normal RV size and systolic function

Features on echo consistent with apical hypertrophic cardiomyopathy. The patient is awaiting an out-patient cardiac MRI given potential DDx of sarcoid.

References / Further Reading

Life in the Fast Lane

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