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Persistent ST segment elevation: a new ECG finding in hypertrophic cardiomyopathy
I A Khan1, F O Ajatta, A W Ansari
1Department of Medicine, Woodhull Medical Center, Brooklyn, NY, USA.
Insights
Hypertrophic cardiomyopathy can present with ST segment elevation mimicking myocardial infarction on ECG. This case highlights the importance of echocardiography in diagnosing this condition, especially in asymptomatic patients.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by unexplained left ventricular hypertrophy.
- HCM can lead to serious complications like sudden cardiac death, particularly in younger individuals.
- Electrocardiogram (ECG) and echocardiography are crucial diagnostic tools for HCM.
Observation:
- The case involved an asymptomatic patient presenting with ST segment elevation on ECG, initially suspected as acute myocardial infarction.
- Cardiac enzymes ruled out myocardial infarction, but the ST segment elevation persisted on serial ECGs.
- Echocardiography revealed hypertrophic cardiomyopathy with left ventricular outflow tract obstruction and a significant pressure gradient.
Findings:
- Persistent ST segment elevation on ECG can be an electrocardiographic manifestation of hypertrophic cardiomyopathy.
- ECG findings in HCM can mimic various other ST-elevation syndromes, including acute myocardial infarction.
- Echocardiography is essential for definitive diagnosis and assessment of hemodynamic significance in suspected HCM.
Implications:
- Recognizing ECG patterns suggestive of HCM is vital to avoid misdiagnosis and delayed treatment.
- This case underscores the necessity of comprehensive cardiac evaluation, including echocardiography, when ECG findings are atypical or persistent.
- Early and accurate diagnosis of hypertrophic cardiomyopathy can guide management and potentially prevent adverse cardiac events.
Abstract:
Hypertrophic cardiomyopathy is a primary disease of myocardium resulting in myocardial hypertrophy without any inciting pressure or volume overload. The typical triad of symptoms includes exertional angina, syncope, and shortness of breath. Sudden cardiac death, the most dreadful complication of this disorder, can be the first manifestation of the disease and is more common in young patients. Elderly patients, on the other hand, may have a relatively benign course with normal or near-normal life span. The electrocardiogram (ECG) and echocardiography are the two most useful measures to diagnose hypertrophic cardiomyopathy. The electrocardiographic features of hypertrophic cardiomyopathy are numerous, including ST segment elevation that may simulate other ST segment elevation syndromes, including acute myocardial infarction, variant angina pectoria, acute pericarditis, bundle branch blocks, ventricular paced rhythm, dyskinetic ventricular segment, ventricular aneurysm, left ventricular hypertrophy, Wolff-Parkinson-White syndrome, and early repolarization syndrome. This report describes a case of an asymptomatic patient who presented with ST segment elevation of acute injury type and, therefore, was admitted to rule out silent myocardial infarction. Myocardial infarction was ruled out by cardiac enzyme levels, but ST segment elevation remained persistent in all of the subsequent ECGs. Echocardiography was performed, which clearly showed hypertrophic cardiomyopathy with left ventricular outflow tract obstruction and a high intracavity pressure gradient. Subsequently, retrieval of old ECGs showed a similar type of ST segment elevation in the patient's previous ECGs.