A Young Man with Recurrent Chest Pain and Dyspnea with Exertion

CaseThis is a young man who has had chest pain and dyspnea with exertion for years. He presented to the ED with these symptoms again. On this occasion, the CP was associated with stress and accompanied by some SOB, 7/10 at it ' s worse and made worse with activity, with radiation up into the left side of his neck and face.No h/o hypertension.Here is the ECG:Probable Diagnosis?I was shown this ECG and gave my opinion, as below.Here is an ED bedside echo, parasternal long axis:Look at the small the end-systolic LV chamber sizeParasternal short axis:Again, look at the end-systolic chamber size!What is the Diagnosis?The ECG shows profound LVH with secondary ST/T abnormalities. There isdeep ST depression and T-wave inversions that are discordant to (in the opposite direction of) large voltage R-waves. These ST-T abnormalitiesdo not represent ischemia, although they could certainly hide ischemia. Instead, these repolarization (ST-T) abnormalities are entirelysecondary to depolarization abnormalities (huge voltage).The echo shows profound LVH. Whether it is definitelyconcentric orassymetric (which is seen in HOCM with assymetric septal hypertrohy) is hard to tell for certain with these bedside echos.Comment: In a young man with no history of hypertension, and with these typical symptoms of hypertrophic cardiomyopathy (HOCM), this is HOCM until proven otherwise.Case continuedHe refused hospital admission. He was discharged with followup for a f...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs