Predicting apical hypertrophic cardiomyopathy using T-wave inversion: Three case reports
Liang Kang1, Yi-Hua Li1, Rong Li2
1The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China.
Insights
Giant negative T waves (GNTs) on ECG may predict apical hypertrophic cardiomyopathy (AHCM) years before structural changes appear. This finding highlights the early diagnostic value of electrocardiograms for AHCM.
Area of Science:
- Cardiology
- Medical Diagnostics
- Electrophysiology
Background:
- Apical hypertrophic cardiomyopathy (AHCM) is a distinct form of hypertrophic cardiomyopathy.
- Left ventricular apical hypertrophy in AHCM can be subtle and challenging to detect via echocardiography.
- Giant negative T waves (GNTs) in precordial leads are characteristic electrocardiogram (ECG) findings in AHCM.
Observation:
- Three patients (68F, 59M, 55F) presented with prolonged chest symptoms (chest tightness, chest pain).
- All patients exhibited GNTs on ECG, observed years before the development of apical hypertrophy.
- Other potential causes for T-wave inversion were excluded in these cases.
Findings:
- Electrophysiological abnormalities, specifically GNTs, manifest earlier than the structural changes (apical hypertrophy) in AHCM.
- ECG findings precede the echocardiographic diagnosis of AHCM by several years in these cases.
Implications:
- ECG, particularly the presence of GNTs, holds significant predictive value for early AHCM detection.
- This suggests a potential role for routine ECG screening in identifying individuals at risk for AHCM.
- Earlier diagnosis of AHCM through ECG can facilitate timely intervention and management.
Background:
Apical hypertrophic cardiomyopathy (AHCM) is a subtype of hypertrophic cardiomyopathy. Due to its location, the thickening of the left ventricular apex can be missed on echocardiography. Giant negative T waves (GNTs) in left-sided chest leads are the hallmark electrocardiogram (ECG) change of AHCM.
Case Summary:
The first patient was a 68-year-old woman complaining of recurrent chest tightness persisting for more than 3 years. The second was a 59-year-old man complaining of spasmodic chest tightness persisting for more than 2 years. The third was a 55-year-old woman complaining of recurrent chest pain persisting for 4 mo. In all three cases, GNTs were observed several years prior to apical cardiac hypertrophy after other causes of T-wave inversion were ruled out.
Conclusion:
Electrophysiological abnormalities of AHCM appear earlier than structural abnormalities, confirming the early predictive value of ECG for AHCM.
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