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- 78 bpm
- Sinus rhythm
- PR - Normal (~180ms)
- QRS - Normal (100ms)
- QT - 360ms (QTc Bazette 410 ms)
- Concave ST elevation leads V2-4
- Nil ST depression
- Voltage criteria for LVH
- R wave V5 + S wave V1 ~35mm
- R wave aVF >20mm
- Narrow deep Q waves leads II, III, aVF, V4-6
- Partial RBBB pattern - rSr' in lead V1
- Given the history of exertional syncope plus LVH with infero-lateral deep Q waves the major concern would be hypertrophic cardiomyopathy.
The ECG changes were appreciated and the patient had a cardiology review and urgent echo. His echo was entirely normal and he was discharged with out-patient cardiology follow-up.
For a bit more on echo findings in HCM and new echo modalities check out the following:
- Williams LK, Frenneaux MP, Steeds RP. Echocardiography in hypertrophic cardiomyopathy diagnosis, prognosis, and role in management. Eur J Echocardiogr. 2009 Dec;10(8):iii9-14 PMID: 19889657 Full text here
- Afonso LC, Bernal J, Bax JJ, Abraham TP. Echocardiography in Hypertrophic Cardiomyopathy The Role of Conventional and Emerging Technologies. J Am Coll Cardiol Img. 2008;1(6):787-800. Full text here.
- Losi MA, Nistri S, Galderisi M, Betocchi S, Cecchi F, Olivotto I, Agricola E, Ballo P, Buralli S, D'Andrea A, D'Errico A, Mele D, Sciomer S, Mondillo S; Working Group of Echocardiography of the Italian Society of Cardiology. Echocardiography in patients with hypertrophic cardiomyopathy: usefulness of old and new techniques in the diagnosis and pathophysiological assessment. Cardiovasc Ultrasound. 2010 Mar 17;8:7. Full text here
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.