ECG of the Week

Presented by: Bill Rooney, M.D.

This week’s ECG is a challenge?

The ECG has findings with significant mortality

implications.

Are you ready???

Obtaining Best Results from this presentation

• Select “From the beginning”

2

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• Slowly click through the presentation• Have fun!---Good luck

The request 3

A 51 year old male applies for $1,000,000 of life insurance.

There is a history of some generalized fatigue, palpitations, and one recent episode of syncope occurring after exercise which was initially felt to be aggravated by dehydration.

One older brother died suddenly a few years back but no specific cause was identified. There has been an echo done recently but the results are not available at the moment.

Luckily you do have an ECG to interpret (are you surprised? I think not! This is, of course, an ECG of the week series!!!)

The ECG 4

Here is the ECG!! How would you interpret this tracing?

The interpretation 5

ANSWER:NSR with rate ~72 bpmPR/QRS/QT intervals appear WNL. • PR ~ 0.16

sec• QRS ~ 0.08

sec• QTc ~ 0.42

secAxis: LAD ~-30o

Hypertrophy: NoneQ waves: Lead III, ? Small r waves in aVFST-T wave changes: ST segment depression noted in leads I, aVL as well as V4-6 with inverted T waves in I, aVL, V2-6

The echo report is obtained and documents the diagnosis of hypertrophic cardiomyopathy.

Hypertrophic Cardiomyopathy—ECG findings 6

A normal ECG is

uncommon! It is seen in

<10% of those with

HCM!!!

Frequently there are

prominent voltages and

repolarization changes

Hypertrophic Cardiomyopathy

Facts to know

However, the ECG changes of HCM are not specific to HCM.

An echocardiogram is frequently needed to help

establish the diagnosis

Q waves, especially in

the inferior and lateral

leads are commonly

seen. This reflects

depolarization of the

hypertrophied septum.

Deeply inverted T waves are

frequently seen—especially in

V2-4.

Left axis deviation is common.

Bi-atrial enlargement is

common

Final Thoughts 7

For further information regarding this condition please refer to Dr. Braun’s Housecalls presentation of 6/26/12.

The link to this presentation is:

http://www.generaliusalifere.com/Publications/Pages/Housecalls.aspx

This concludes this week’s ECG of the week. Contact me if you have

questions!