This ECG was recorded from an essentially asymptomatic 55-year old male after his GP noticed that he was bradycardic during a routine check-up. He had no family history of note, was not taking any medication and his blood pressure was 130/90 mm Hg. Does the ECG suggest any particular diagnosis?
Note that the chest leads were recorded at half standardisation (5 mm/mV).
Dr Dave Richley,
Associate Lecturer
Newcastle University
Apical HCM – LVH, marked T-wave inversion and P-mitrale
Tim is spot-on. This is a case of apical hypertrophic cardiomyopathy (Yamaguchi syndrome), a variety of hypertrophic cardiomyopathy in which the hypertrophy predominantly affects the left ventricular apex. This hereditary disease is relatively common in Japan but rare elsewhere. The characteristic ECG features of the condition are QRS complexes of high amplitude that fulfil the criteria for left ventricular hypertrophy (LVH) and deep, symmetrical T wave inversion in the chest leads. These features are shown well in the ECG here which, in addition to satisfying the standard voltage criteria for LVH, has more widespread T wave inversion than is normally seen in LVH, with particularly deep T wave inversion – up to 1.4 mV – in V3 and V4.
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