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- 84 bpm
- Sinus Rhythm
- PR - Normal (~200ms)
- QRS - Normal (110ms)
- QT - 400ms (QTc Bazette 435 ms)
- ST depression leads I, II, V4-6
- Deep T wave inversion leads I, II, aVL, aVF, V3-6
- QRS voltages in infero-lateral leads appear high without meeting LVH criteria
- 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.
- 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
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.