Hypertrophic cardiomyopathy electrocardiogram: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(/* 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT){{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, To...)
No edit summary
 
(13 intermediate revisions by 5 users not shown)
Line 1: Line 1:
__NOTOC__
{{Hypertrophic cardiomyopathy}}
{{Hypertrophic cardiomyopathy}}


'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], Martin S. Maron, M.D., and Barry J. Maron, M.D.
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], Martin S. Maron, M.D., and Barry J. Maron, M.D. {{Soroush}}


==Overview==
==Overview==
Common findings on an EKG in a patient with hypertrophic cardiomyopathy include [[tall R wave]]s, deep Q waves, [[inverted T wave]]s, ST segment abnormalities and '[[strain pattern]]' in the chest leads.  The deep Q waves indicate septal hypertrophy and similarly deeply inverted T waves indicate atypical apical hypertrophy.
A [[The electrocardiogram|12 lead EKG]] is strongly recommended at the time of the initial diagnosis of hypertrophic cardiomyopathy.  Common findings on an [[The electrocardiogram|EKG]] in these patients include tall [[R waves]], deep [[Q waves]], [[inverted T wave]]s, [[ST segments|ST segment]] abnormalities and '[[strain pattern]]' in the chest leads.  The deep [[Q waves]] indicate septal hypertrophy and similarly deeply inverted [[T waves]] indicate apical hypertrophy.


==Electrocardiogram==
==Electrocardiogram==
Large septal q waves may be present reflective of the septal hypertrophy. In the Yamaguchi variant of apical hypertrophic cardiomyopathy there may be deeply inverted T waves in precordial leads V2-V6 and II, III, aVL (see example).
Large septal [[Q waves]] may be present reflective of the septal hypertrophy. In the Yamaguchi variant of apical hypertrophic cardiomyopathy, there may be deeply inverted [[T waves]] in precordial leads V2-V6 and II, III, aVL (see example).


Shown below is an example of a variant of apical hypertrophic cardiomyopathy with deeply inverted T waves in precordial leads V2-V6 and II, III, aVL.  
Shown below is an example of a variant of apical hypertrophic cardiomyopathy with deeply inverted [[T waves]] in precordial leads V2-V6 and II, III, aVL.  
[[Image:HCP ecg.JPG|center|500px]]
[[Image:HCP ecg.JPG|center|500px]]
----
----




Shown below is an example of hypertrophic cardiomyopathy with abnormal ST segments, deeply flipped T waves, tall R apical waves, deep Q waves. "Strain pattern" can be observed in the precordial leads.
Shown below is an example of hypertrophic cardiomyopathy with abnormal [[ST segments]], deeply flipped [[T waves]], tall [[R waves|R apical waves]], deep [[Q waves]]. "Strain pattern" can be observed in the [[precordial leads]].


[[Image:Hypertrophic_Cardiomyopathy.jpg||center|500px]]
[[Image:Hypertrophic_Cardiomyopathy.jpg||center|500px]]
Line 21: Line 22:




Shown below is an example of hypertrophic cardiomyopathy with ST depression in the lateral leads, deeper S waves in the right precordial leads and tall R waves in the left precordial leads with T wave inversions indicating "strain pattern"  
Shown below is an example of hypertrophic cardiomyopathy with [[ST depression]] in the lateral leads, deeper [[S wave|S waves]] in the right [[precordial leads]] and tall [[R waves]] in the left [[precordial leads]] with [[T waves|T wave]] inversions indicating "strain pattern".
[[Image:Hypertrophic cardiomyopathy.jpg|center|500px]]
[[Image:Hypertrophic cardiomyopathy.jpg|center|500px]]


'''Yamagouchi'''
Yamaguchi syndrome or apical hypertrophy  pseudoacute coronary syndrome might be observed on [[ECG]]. [[The electrocardiogram|ECG]] findings might show left ventricular hypertrophy as well as diffuse T-wave inversions over the inferior and anterolateral leads
<br />
----
----
== 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart  Association Joint Committee on Clinical Practice Guidelines<ref name="pmid33215931">{{cite journal| author=Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P | display-authors=etal| title=2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2020 | volume= 142 | issue= 25 | pages= e558-e631 | pmid=33215931 | doi=10.1161/CIR.0000000000000937 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33215931  }}</ref> ==
=== Recommendations for Heart Rhythm Assessment Referenced studies that support the recommendations are summarized in Online Data Supplement ===
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |1. In patients with HCM, a 12-lead ECG is recommended in the initial evaluation and as part of periodic follow-up (every 1 to 2 years)''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
2. In patients with HCM, 24- to 48-hour  ambulatory electrocardiographic monitoring is recommended in the initial evaluation  and as part of periodic follow-up (every 1 to 2 years) to identify patients who are at risk for SCD and guide management of arrhythmias''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]-NR)''
3. In patients with HCM who develop palpitations or lightheadedness, extended (>24 hours) electrocardiographic monitoring or event recording is recommended, which should not be considered diagnostic unless patients have had symptoms while being monitored''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
4. In first-degree relatives of patients with HCM, a 12-lead ECG is recommended as a component of the screening algorithm''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
|}
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon" |5. In patients with HCM who have additional risk factors for AF, such as left atrial dilatation, advanced age, and New York Heart Association (NYHA) class III to class IV HF, and who are eligible for anticoagulation, extended ambulatory monitoring is reasonable to screen for AF as part of initial evaluation and periodic follow-up (every 1 to 2 years)''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
|}
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
| bgcolor="LemonChiffon" |6. In adult patients with HCM without risk fac-tors for AF and who are eligible for anticoagulation, extended ambulatory monitoring may be considered to assess for asymptomatic paroxysmal AF as part of initial evaluation and periodic follow-up (every 1 to 2 years)''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])''
|}


==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>==
==2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>==
Line 34: Line 70:
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|colspan="1" style="text-align:center; background:LightGreen"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' In individuals with pathogenic mutations who do not express the [[HOCM]] phenotype, it is recommended to perform serial [[Hypertrophic cardiomyopathy diagnostic testing#Electrocardiogram|electrocardiogram]], [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|TTE]], and [[Hypertrophic cardiomyopathy physical examination|clinical assessment]] at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status.<ref name="pmid19539541">{{cite journal |author=Christiaans I, Lekanne dit Deprez RH, van Langen IM, Wilde AA |title=Ventricular fibrillation in MYH7-related hypertrophic cardiomyopathy before onset of ventricular hypertrophy |journal=[[Heart Rhythm : the Official Journal of the Heart Rhythm Society]] |volume=6 |issue=9 |pages=1366–9 |year=2009 |month=September |pmid=19539541 |doi=10.1016/j.hrthm.2009.04.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S1547-5271(09)00464-0 |accessdate=2011-12-22}}</ref><ref name="pmid19035361">{{cite journal |author=Andersen PS, Havndrup O, Hougs L, Sørensen KM, Jensen M, Larsen LA, Hedley P, Thomsen AR, Moolman-Smook J, Christiansen M, Bundgaard H |title=Diagnostic yield, interpretation, and clinical utility of mutation screening of sarcomere encoding genes in Danish hypertrophic cardiomyopathy patients and relatives |journal=[[Human Mutation]] |volume=30 |issue=3 |pages=363–70 |year=2009 |month=March |pmid=19035361 |doi=10.1002/humu.20862 |url=http://dx.doi.org/10.1002/humu.20862 |accessdate=2011-12-22}}</ref><ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid19666645">{{cite journal |author=Michels M, Soliman OI, Phefferkorn J, Hoedemaekers YM, Kofflard MJ, Dooijes D, Majoor-Krakauer D, Ten Cate FJ |title=Disease penetrance and risk stratification for sudden cardiac death in asymptomatic hypertrophic cardiomyopathy mutation carriers |journal=[[European Heart Journal]] |volume=30 |issue=21 |pages=2593–8 |year=2009 |month=November |pmid=19666645 |doi=10.1093/eurheartj/ehp306 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=19666645 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' In individuals with pathogenic mutations who do not express the [[HOCM|HCM]] phenotype, it is recommended to perform serial [[Hypertrophic cardiomyopathy diagnostic testing#Electrocardiogram|electrocardiogram (ECG)]], [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|transthoracic echocardiogram (TTE)]], and [[Hypertrophic cardiomyopathy physical examination|clinical assessment]] at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status.<ref name="pmid19539541">{{cite journal |author=Christiaans I, Lekanne dit Deprez RH, van Langen IM, Wilde AA |title=Ventricular fibrillation in MYH7-related hypertrophic cardiomyopathy before onset of ventricular hypertrophy |journal=[[Heart Rhythm : the Official Journal of the Heart Rhythm Society]] |volume=6 |issue=9 |pages=1366–9 |year=2009 |month=September |pmid=19539541 |doi=10.1016/j.hrthm.2009.04.029 |url=http://linkinghub.elsevier.com/retrieve/pii/S1547-5271(09)00464-0 |accessdate=2011-12-22}}</ref><ref name="pmid19035361">{{cite journal |author=Andersen PS, Havndrup O, Hougs L, Sørensen KM, Jensen M, Larsen LA, Hedley P, Thomsen AR, Moolman-Smook J, Christiansen M, Bundgaard H |title=Diagnostic yield, interpretation, and clinical utility of mutation screening of sarcomere encoding genes in Danish hypertrophic cardiomyopathy patients and relatives |journal=[[Human Mutation]] |volume=30 |issue=3 |pages=363–70 |year=2009 |month=March |pmid=19035361 |doi=10.1002/humu.20862 |url=http://dx.doi.org/10.1002/humu.20862 |accessdate=2011-12-22}}</ref><ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid19666645">{{cite journal |author=Michels M, Soliman OI, Phefferkorn J, Hoedemaekers YM, Kofflard MJ, Dooijes D, Majoor-Krakauer D, Ten Cate FJ |title=Disease penetrance and risk stratification for sudden cardiac death in asymptomatic hypertrophic cardiomyopathy mutation carriers |journal=[[European Heart Journal]] |volume=30 |issue=21 |pages=2593–8 |year=2009 |month=November |pmid=19666645 |doi=10.1093/eurheartj/ehp306 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=19666645 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>


|}
|}
Line 44: Line 80:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' 1. A 12-lead ECG is recommended in the initial evaluation of patients with [[HOCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A 12-lead ECG is recommended in the initial evaluation of patients with [[HOCM|HCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring is recommended in the initial evaluation of patients with [[HOCM]] to detect [[ventricular tachycardia]] (VT) and identify patients who may be candidates for [[Implantable cardioverter-defibrillator|ICD therapy]].<ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid16754630">{{cite journal |author=Elliott PM, Gimeno JR, Tomé MT, Shah J, Ward D, Thaman R, Mogensen J, McKenna WJ |title=Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy |journal=[[European Heart Journal]] |volume=27 |issue=16 |pages=1933–41 |year=2006 |month=August |pmid=16754630 |doi=10.1093/eurheartj/ehl041 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16754630 |accessdate=2011-12-22}}</ref><ref name="pmid7196685">{{cite journal |author=Maron BJ, Savage DD, Wolfson JK, Epstein SE |title=Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study |journal=[[The American Journal of Cardiology]] |volume=48 |issue=2 |pages=252–7 |year=1981 |month=August |pmid=7196685 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(81)90604-4 |accessdate=2011-12-22}}</ref><ref name="pmid12957435">{{cite journal |author=Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ |title=Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=5 |pages=873–9 |year=2003 |month=September |pmid=12957435 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703008271 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring is recommended in the initial evaluation of patients with [[HOCM|HCM]] to detect [[ventricular tachycardia]] (VT) and identify patients who may be candidates for [[Implantable cardioverter-defibrillator|ICD therapy]].<ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid16754630">{{cite journal |author=Elliott PM, Gimeno JR, Tomé MT, Shah J, Ward D, Thaman R, Mogensen J, McKenna WJ |title=Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy |journal=[[European Heart Journal]] |volume=27 |issue=16 |pages=1933–41 |year=2006 |month=August |pmid=16754630 |doi=10.1093/eurheartj/ehl041 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16754630 |accessdate=2011-12-22}}</ref><ref name="pmid7196685">{{cite journal |author=Maron BJ, Savage DD, Wolfson JK, Epstein SE |title=Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study |journal=[[The American Journal of Cardiology]] |volume=48 |issue=2 |pages=252–7 |year=1981 |month=August |pmid=7196685 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(81)90604-4 |accessdate=2011-12-22}}</ref><ref name="pmid12957435">{{cite journal |author=Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ |title=Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=5 |pages=873–9 |year=2003 |month=September |pmid=12957435 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703008271 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring or event recording is recommended in patients with [[HOCM]] who develop [[palpitations]] or [[lightheadedness]].<ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid16754630">{{cite journal |author=Elliott PM, Gimeno JR, Tomé MT, Shah J, Ward D, Thaman R, Mogensen J, McKenna WJ |title=Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy |journal=[[European Heart Journal]] |volume=27 |issue=16 |pages=1933–41 |year=2006 |month=August |pmid=16754630 |doi=10.1093/eurheartj/ehl041 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16754630 |accessdate=2011-12-22}}</ref><ref name="pmid7196685">{{cite journal |author=Maron BJ, Savage DD, Wolfson JK, Epstein SE |title=Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study |journal=[[The American Journal of Cardiology]] |volume=48 |issue=2 |pages=252–7 |year=1981 |month=August |pmid=7196685 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(81)90604-4 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring or event recording is recommended in patients with [[HOCM|HCM]] who develop [[palpitations]] or [[lightheadedness]].<ref name="pmid20019025">{{cite journal |author=Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA |title=The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening |journal=[[European Heart Journal]] |volume=31 |issue=7 |pages=842–8 |year=2010 |month=April |pmid=20019025 |doi=10.1093/eurheartj/ehp539 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=20019025 |accessdate=2011-12-22}}</ref><ref name="pmid16754630">{{cite journal |author=Elliott PM, Gimeno JR, Tomé MT, Shah J, Ward D, Thaman R, Mogensen J, McKenna WJ |title=Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy |journal=[[European Heart Journal]] |volume=27 |issue=16 |pages=1933–41 |year=2006 |month=August |pmid=16754630 |doi=10.1093/eurheartj/ehl041 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=16754630 |accessdate=2011-12-22}}</ref><ref name="pmid7196685">{{cite journal |author=Maron BJ, Savage DD, Wolfson JK, Epstein SE |title=Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study |journal=[[The American Journal of Cardiology]] |volume=48 |issue=2 |pages=252–7 |year=1981 |month=August |pmid=7196685 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(81)90604-4 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' A repeat ECG is recommended for patients with [[HOCM]] when there is worsening of symptoms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' A repeat ECG is recommended for patients with [[HOCM|HCM]] when there is worsening of symptoms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' A 12-lead ECG is recommended every 12 to 18 months as a component of the screening algorithm for adolescent first-degree relatives of patients with [[HOCM]] who have no evidence of hypertrophy on [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|echocardiography]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' A 12-lead ECG is recommended every 12 to 18 months as a component of the screening algorithm for adolescent first-degree relatives of patients with [[HOCM|HCM]] who have no evidence of hypertrophy on [[Hypertrophic cardiomyopathy diagnostic testing#Echocardiography|echocardiography]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' A 12-lead ECG is recommended as a component of the [[Hypertrophic cardiomyopathy screening|screening]] algorithm for first-degree relatives of patients with [[HOCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' A 12-lead ECG is recommended as a component of the [[Hypertrophic cardiomyopathy screening|screening]] algorithm for first-degree relatives of patients with [[HOCM|HCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 61: Line 97:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring, repeated every 1 to 2 years, is reasonable in patients with [[HOCM]] who have no previous evidence of [[ventricular tachycardia|VT]] to identify patients who may be candidates for [[Implantable cardioverter-defibrillator|ICD therapy]].<ref name="pmid12957435">{{cite journal |author=Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ |title=Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=5 |pages=873–9 |year=2003 |month=September |pmid=12957435 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703008271 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring, repeated every 1 to 2 years, is reasonable in patients with [[HOCM|HCM]] who have no previous evidence of [[ventricular tachycardia|VT]] to identify patients who may be candidates for [[Implantable cardioverter-defibrillator|ICD therapy]].<ref name="pmid12957435">{{cite journal |author=Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ |title=Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=5 |pages=873–9 |year=2003 |month=September |pmid=12957435 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703008271 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Annual 12-lead ECGs are reasonable in patients with known [[HOCM]] who are clinically stable to evaluate for asymptomatic changes in conduction or rhythm (i.e., [[Atrial fibrillation|AF]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Annual 12-lead ECGs are reasonable in patients with known [[HOCM|HCM]] who are clinically stable to evaluate for asymptomatic changes in conduction or rhythm (i.e., [[Atrial fibrillation| atrial fibrillation (AF)]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 70: Line 106:
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring might be considered in adults with [[HOCM]] to assess for asymptomatic paroxysmal [[Atrial fibrillation|AF]]/[[atrial flutter]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring might be considered in adults with [[HOCM|HCM]] to assess for asymptomatic paroxysmal [[Atrial fibrillation|AF]]/[[atrial flutter]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
 
==Stress Test==
 
===Stress Testing (DO NOT EDIT)<ref name="pmid22075469">{{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=[[Journal of the American College of Cardiology]] |volume=58 |issue=25 |pages=e212–60 |year=2011 |month=December |pmid=22075469 |doi=10.1016/j.jacc.2011.06.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(11)02275-3 |accessdate=2011-12-19}}</ref>===
 
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with [[HOCM]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
 
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Treadmill testing with monitoring of an ECG and blood pressure is reasonable for [[Hypertrophic cardiomyopathy risk factors for sudden death|SCD risk stratification]] in patients with [[HOCM]].<ref name="pmid9386166">{{cite journal |author=Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ |title=Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy |journal=[[Circulation]] |volume=96 |issue=9 |pages=2987–91 |year=1997 |month=November |pmid=9386166 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9386166 |accessdate=2011-12-22}}</ref><ref name="pmid10362212">{{cite journal |author=Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F |title=Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy |journal=[[Journal of the American College of Cardiology]] |volume=33 |issue=7 |pages=2044–51 |year=1999 |month=June |pmid=10362212 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00094-7 |accessdate=2011-12-22}}</ref><ref name="pmid12106932">{{cite journal |author=Ciampi Q, Betocchi S, Lombardi R, Manganelli F, Storto G, Losi MA, Pezzella E, Finizio F, Cuocolo A, Chiariello M |title=Hemodynamic determinants of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy |journal=[[Journal of the American College of Cardiology]] |volume=40 |issue=2 |pages=278–84 |year=2002 |month=July |pmid=12106932 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702019502 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' In patients with [[HOCM]] who do not have a resting peak instantaneous gradient of greater than or equal to 50 mm Hg, [[Exercise stress testing#Exercise/Pharmacologic Stress Echocardiography|exercise echocardiography]] is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction.<ref name="pmid17088454">{{cite journal |author=Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, Nistri S, Cecchi F, Udelson JE, Maron BJ |title=Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction |journal=[[Circulation]] |volume=114 |issue=21 |pages=2232–9 |year=2006 |month=November |pmid=17088454 |doi=10.1161/CIRCULATIONAHA.106.644682 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17088454 |accessdate=2011-12-22}}</ref><ref name="pmid2242524">{{cite journal |author=Frenneaux MP, Counihan PJ, Caforio AL, Chikamori T, McKenna WJ |title=Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy |journal=[[Circulation]] |volume=82 |issue=6 |pages=1995–2002 |year=1990 |month=December |pmid=2242524 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=2242524 |accessdate=2011-12-22}}</ref><ref name="pmid9386166">{{cite journal |author=Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ |title=Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy |journal=[[Circulation]] |volume=96 |issue=9 |pages=2987–91 |year=1997 |month=November |pmid=9386166 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9386166 |accessdate=2011-12-22}}</ref><ref name="pmid10362212">{{cite journal |author=Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F |title=Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy |journal=[[Journal of the American College of Cardiology]] |volume=33 |issue=7 |pages=2044–51 |year=1999 |month=June |pmid=10362212 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00094-7 |accessdate=2011-12-22}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
|}


Latest revision as of 07:05, 9 December 2022

Hypertrophic Cardiomyopathy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypertrophic Cardiomyopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypertrophic cardiomyopathy electrocardiogram On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypertrophic cardiomyopathy electrocardiogram

CDC on Hypertrophic cardiomyopathy electrocardiogram

Hypertrophic cardiomyopathy electrocardiogram in the news

Blogs on Hypertrophic cardiomyopathy electrocardiogram

Directions to Hospitals Treating Hypertrophic cardiomyopathy

Risk calculators and risk factors for Hypertrophic cardiomyopathy electrocardiogram

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1], Martin S. Maron, M.D., and Barry J. Maron, M.D. Soroush Seifirad, M.D.[2]

Overview

A 12 lead EKG is strongly recommended at the time of the initial diagnosis of hypertrophic cardiomyopathy. Common findings on an EKG in these patients include tall R waves, deep Q waves, inverted T waves, ST segment abnormalities and 'strain pattern' in the chest leads. The deep Q waves indicate septal hypertrophy and similarly deeply inverted T waves indicate apical hypertrophy.

Electrocardiogram

Large septal Q waves may be present reflective of the septal hypertrophy. In the Yamaguchi variant of apical hypertrophic cardiomyopathy, there may be deeply inverted T waves in precordial leads V2-V6 and II, III, aVL (see example).

Shown below is an example of a variant of apical hypertrophic cardiomyopathy with deeply inverted T waves in precordial leads V2-V6 and II, III, aVL.


Shown below is an example of hypertrophic cardiomyopathy with abnormal ST segments, deeply flipped T waves, tall R apical waves, deep Q waves. "Strain pattern" can be observed in the precordial leads.


Shown below is an example of hypertrophic cardiomyopathy with ST depression in the lateral leads, deeper S waves in the right precordial leads and tall R waves in the left precordial leads with T wave inversions indicating "strain pattern".


Yamagouchi

Yamaguchi syndrome or apical hypertrophy pseudoacute coronary syndrome might be observed on ECG. ECG findings might show left ventricular hypertrophy as well as diffuse T-wave inversions over the inferior and anterolateral leads


2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart  Association Joint Committee on Clinical Practice Guidelines[1]

Recommendations for Heart Rhythm Assessment Referenced studies that support the recommendations are summarized in Online Data Supplement

Class I
1. In patients with HCM, a 12-lead ECG is recommended in the initial evaluation and as part of periodic follow-up (every 1 to 2 years)(Level of Evidence: B-NR)

2. In patients with HCM, 24- to 48-hour  ambulatory electrocardiographic monitoring is recommended in the initial evaluation  and as part of periodic follow-up (every 1 to 2 years) to identify patients who are at risk for SCD and guide management of arrhythmias(Level of Evidence: B-NR) 3. In patients with HCM who develop palpitations or lightheadedness, extended (>24 hours) electrocardiographic monitoring or event recording is recommended, which should not be considered diagnostic unless patients have had symptoms while being monitored(Level of Evidence: B-NR) 4. In first-degree relatives of patients with HCM, a 12-lead ECG is recommended as a component of the screening algorithm(Level of Evidence: B-NR)

Class IIa
5. In patients with HCM who have additional risk factors for AF, such as left atrial dilatation, advanced age, and New York Heart Association (NYHA) class III to class IV HF, and who are eligible for anticoagulation, extended ambulatory monitoring is reasonable to screen for AF as part of initial evaluation and periodic follow-up (every 1 to 2 years)(Level of Evidence: B-NR)
Class IIb
6. In adult patients with HCM without risk fac-tors for AF and who are eligible for anticoagulation, extended ambulatory monitoring may be considered to assess for asymptomatic paroxysmal AF as part of initial evaluation and periodic follow-up (every 1 to 2 years)(Level of Evidence: B-NR)


2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)[2]

Genotype-Positive/Phenotype-Negative Patients (DO NOT EDIT)[2]

Class I
"1. In individuals with pathogenic mutations who do not express the HCM phenotype, it is recommended to perform serial electrocardiogram (ECG), transthoracic echocardiogram (TTE), and clinical assessment at periodic intervals (12 to 18 months in children and adolescents and about every 5 years in adults), based on the patient’s age and change in clinical status.[3][4][5][6] (Level of Evidence: B)"

Electrocardiography (DO NOT EDIT)[2]

Class I
"1. A 12-lead ECG is recommended in the initial evaluation of patients with HCM. (Level of Evidence: C)"
"2. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring is recommended in the initial evaluation of patients with HCM to detect ventricular tachycardia (VT) and identify patients who may be candidates for ICD therapy.[5][7][8][9] (Level of Evidence: B)"
"3. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring or event recording is recommended in patients with HCM who develop palpitations or lightheadedness.[5][7][8] (Level of Evidence: B)"
"4. A repeat ECG is recommended for patients with HCM when there is worsening of symptoms. (Level of Evidence: C)"
"5. A 12-lead ECG is recommended every 12 to 18 months as a component of the screening algorithm for adolescent first-degree relatives of patients with HCM who have no evidence of hypertrophy on echocardiography. (Level of Evidence: C)"
"6. A 12-lead ECG is recommended as a component of the screening algorithm for first-degree relatives of patients with HCM. (Level of Evidence: C)"
Class IIa
"1. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring, repeated every 1 to 2 years, is reasonable in patients with HCM who have no previous evidence of VT to identify patients who may be candidates for ICD therapy.[9] (Level of Evidence: C)"
"2. Annual 12-lead ECGs are reasonable in patients with known HCM who are clinically stable to evaluate for asymptomatic changes in conduction or rhythm (i.e., atrial fibrillation (AF)). (Level of Evidence: C)"
Class IIb
"1. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring might be considered in adults with HCM to assess for asymptomatic paroxysmal AF/atrial flutter. (Level of Evidence: C)"

References

  1. ↑ Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P; et al. (2020). "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 142 (25): e558–e631. doi:10.1161/CIR.0000000000000937. PMID 33215931 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  3. ↑ Christiaans I, Lekanne dit Deprez RH, van Langen IM, Wilde AA (2009). "Ventricular fibrillation in MYH7-related hypertrophic cardiomyopathy before onset of ventricular hypertrophy". Heart Rhythm : the Official Journal of the Heart Rhythm Society. 6 (9): 1366–9. doi:10.1016/j.hrthm.2009.04.029. PMID 19539541. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  4. ↑ Andersen PS, Havndrup O, Hougs L, Sørensen KM, Jensen M, Larsen LA, Hedley P, Thomsen AR, Moolman-Smook J, Christiansen M, Bundgaard H (2009). "Diagnostic yield, interpretation, and clinical utility of mutation screening of sarcomere encoding genes in Danish hypertrophic cardiomyopathy patients and relatives". Human Mutation. 30 (3): 363–70. doi:10.1002/humu.20862. PMID 19035361. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  5. ↑ 5.0 5.1 5.2 Christiaans I, Birnie E, van Langen IM, van Spaendonck-Zwarts KY, van Tintelen JP, van den Berg MP, Atsma DE, Helderman-van den Enden AT, Pinto YM, Hermans-van Ast JF, Bonsel GJ, Wilde AA (2010). "The yield of risk stratification for sudden cardiac death in hypertrophic cardiomyopathy myosin-binding protein C gene mutation carriers: focus on predictive screening". European Heart Journal. 31 (7): 842–8. doi:10.1093/eurheartj/ehp539. PMID 20019025. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  6. ↑ Michels M, Soliman OI, Phefferkorn J, Hoedemaekers YM, Kofflard MJ, Dooijes D, Majoor-Krakauer D, Ten Cate FJ (2009). "Disease penetrance and risk stratification for sudden cardiac death in asymptomatic hypertrophic cardiomyopathy mutation carriers". European Heart Journal. 30 (21): 2593–8. doi:10.1093/eurheartj/ehp306. PMID 19666645. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Elliott PM, Gimeno JR, Tomé MT, Shah J, Ward D, Thaman R, Mogensen J, McKenna WJ (2006). "Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy". European Heart Journal. 27 (16): 1933–41. doi:10.1093/eurheartj/ehl041. PMID 16754630. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 Maron BJ, Savage DD, Wolfson JK, Epstein SE (1981). "Prognostic significance of 24 hour ambulatory electrocardiographic monitoring in patients with hypertrophic cardiomyopathy: a prospective study". The American Journal of Cardiology. 48 (2): 252–7. PMID 7196685. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ (2003). "Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients". Journal of the American College of Cardiology. 42 (5): 873–9. PMID 12957435. Retrieved 2011-12-22. Unknown parameter |month= ignored (help)
Retrieved from "https://www.wikidoc.org/index.php?title=Hypertrophic_cardiomyopathy_electrocardiogram&oldid=1731995"