Hypertrophic cardiomyopathy electrocardiogram
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1], Martin S. Maron, M.D., and Barry J. Maron, M.D.
Overview
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"
2011 ACCF/AHA Guideline Recommendations: Electrocardiography [1][2] (DO NOT EDIT)
| Class I |
| 1. 1. A 12-lead ECG is recommended in the initial evaluation of patients with HOCM. (Level of Evidence: C) |
| 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 ICD therapy.[3][4][5][6] (Level of Evidence: B) |
| 3. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring or event recording is recommended in patients with HOCM who develop palpitations or lightheadedness.[3][4][5] (Level of Evidence: B) |
| 4. A repeat ECG is recommended for patients with HOCM 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 HOCM 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 HOCM. (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 HOCM who have no previous evidence of VT to identify patients who may be candidates for ICD therapy.[6] (Level of Evidence: C) |
| 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., AF). (Level of Evidence: C) |
| Class IIb |
| 1. Twenty-four–hour ambulatory (Holter) electrocardiographic monitoring might be considered in adults with HOCM to assess for asymptomatic paroxysmal AF/atrial flutter. (Level of Evidence: C) |
Stress Test
2011 ACCF/AHA Guideline Recommendations: Stress Testing [1][2]
| Class IIa |
| 1. Treadmill exercise testing is reasonable to determine functional capacity and response to therapy in patients with HOCM. (Level of Evidence: C) |
| 2. Treadmill testing with monitoring of an ECG and blood pressure is reasonable for SCD risk stratification in patients with HOCM.[7][8][9] (Level of Evidence: B) |
| 3. In patients with HOCM who do not have a resting peak instantaneous gradient of greater than or equal to 50 mm Hg, exercise echocardiography is reasonable for the detection and quantification of exercise-induced dynamic LVOT obstruction.[10][11][7][8] (Level of Evidence: B) |
References
- ↑ 1.0 1.1 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: Executive Summary 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): 2703–38. doi:10.1016/j.jacc.2011.10.825. PMID 22075468. Retrieved 2011-12-19. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 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) - ↑ 3.0 3.1 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) - ↑ 4.0 4.1 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) - ↑ 5.0 5.1 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) - ↑ 6.0 6.1 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) - ↑ 7.0 7.1 Sadoul N, Prasad K, Elliott PM, Bannerjee S, Frenneaux MP, McKenna WJ (1997). "Prospective prognostic assessment of blood pressure response during exercise in patients with hypertrophic cardiomyopathy". Circulation. 96 (9): 2987–91. PMID 9386166. Retrieved 2011-12-22. Unknown parameter
|month=ignored (help) - ↑ 8.0 8.1 Olivotto I, Maron BJ, Montereggi A, Mazzuoli F, Dolara A, Cecchi F (1999). "Prognostic value of systemic blood pressure response during exercise in a community-based patient population with hypertrophic cardiomyopathy". Journal of the American College of Cardiology. 33 (7): 2044–51. PMID 10362212. Retrieved 2011-12-22. Unknown parameter
|month=ignored (help) - ↑ Ciampi Q, Betocchi S, Lombardi R, Manganelli F, Storto G, Losi MA, Pezzella E, Finizio F, Cuocolo A, Chiariello M (2002). "Hemodynamic determinants of exercise-induced abnormal blood pressure response in hypertrophic cardiomyopathy". Journal of the American College of Cardiology. 40 (2): 278–84. PMID 12106932. Retrieved 2011-12-22. Unknown parameter
|month=ignored (help) - ↑ Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, Nistri S, Cecchi F, Udelson JE, Maron BJ (2006). "Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction". Circulation. 114 (21): 2232–9. doi:10.1161/CIRCULATIONAHA.106.644682. PMID 17088454. Retrieved 2011-12-22. Unknown parameter
|month=ignored (help) - ↑ Frenneaux MP, Counihan PJ, Caforio AL, Chikamori T, McKenna WJ (1990). "Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy". Circulation. 82 (6): 1995–2002. PMID 2242524. Retrieved 2011-12-22. Unknown parameter
|month=ignored (help)