An elderly patient with stuttering chest pain. Don ' t jump to conclusions.

I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis:What do you think?I went to the patient ' s chart:Elderly woman with stuttering chest pain and SOB, and dizziness.What do you think now?This is a very typical ECG for Hypertrophic Cardiomyopathy. I sent it to our EKG Nerdz group and Jesse McLaren replied: " Apical HOCM "It reminded me of many other cases I have seen, such as this one: Left Bundle Branch Block with Less Than 1 mm of Concordant ST Elevation (in the Setting of Hypertrophic Cardiomyopathy)HOCM that mimicked LBBB with OMI (concordant STE in V5)Case continuedSo I went to the chart and this is what I found:She indeed had a history of hypertrophic cardiomyopathy (HOCM).  The first troponin was 52 ng/L (URL = 16 ng/L, so this is slightly elevated.  The most recent previous was 4 years prior, and was in the normal range)Elderly patients,and patients with cardiomyopathy (including HOCM), may have troponin values in this range chronically ( " chronic myocardial injury " ).  I suspected this was the case, and that in 4 years time she had developed some chronic injury.  She had serial troponins in the ED that remained constant.Here is what The Queen of Hearts thought of this ECG:The telegram version of Queen of Hearts only gives an output of OMI or Not OMI, with various confidence levels.  The full PM Cardio app (see below) gives the full range of EKG diagnoses.ExplainabilityNotice i...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs