1. ECG of the Week Presented by: Bill Rooney, M.D. Presented by: Bill Rooney, M.D. This week’s ECG is a challenge? The ECG has findings with significant mortality implications. Are you ready???

2. Obtaining Best Results from this presentation Select “From the beginning” 2 For best results—please do the following: Select “Slide Show” from the menu option on top For best results—please do the following: Select “Slide Show” from the menu option on top Slowly click through the presentation Have fun!---Good luck Slowly click through the presentation Have fun!---Good luck

3. The request 3 A 51 year old male applies for $1,000,000 of life insurance. There is a history of some generalized fatigue, palpitations, and one recent episode of syncope occurring after exercise which was initially felt to be aggravated by dehydration. One older brother died suddenly a few years back but no specific cause was identified. There has been an echo done recently but the results are not available at the moment. Luckily you do have an ECG to interpret (are you surprised? I think not! This is, of course, an ECG of the week series!!!)

4. The ECG 4 Here is the ECG!! How would you interpret this tracing? Here is the ECG!! How would you interpret this tracing?

5. The interpretation 5 ANSWER: NSR with rate ~72 bpm PR/QRS/QT intervals appear WNL. PR ~ 0.16 sec QRS ~ 0.08 sec QT c ~ 0.42 sec Axis: LAD ~-30 o Hypertrophy: None Q waves: Lead III, ? Small r waves in aVF ST-T wave changes: ST segment depression noted in leads I, aVL as well as V4-6 with inverted T waves in I, aVL, V2-6 ANSWER: NSR with rate ~72 bpm PR/QRS/QT intervals appear WNL. PR ~ 0.16 sec QRS ~ 0.08 sec QT c ~ 0.42 sec Axis: LAD ~-30 o Hypertrophy: None Q waves: Lead III, ? Small r waves in aVF ST-T wave changes: ST segment depression noted in leads I, aVL as well as V4-6 with inverted T waves in I, aVL, V2-6 The echo report is obtained and documents the diagnosis of hypertrophic cardiomyopathy.

6. Hypertrophic Cardiomyopathy—ECG findings 6 A normal ECG is uncommon! It is seen in <10% of those with HCM!!! Frequently there are prominent voltages and repolarization changes However, the ECG changes of HCM are not specific to HCM. An echocardiogram is frequently needed to help establish the diagnosis Q waves, especially in the inferior and lateral leads are commonly seen. This reflects depolarization of the hypertrophied septum. Deeply inverted T waves are frequently seen—especially in V2-4. Left axis deviation is common. Bi-atrial enlargement is common Deeply inverted T waves are frequently seen—especially in V2-4. Left axis deviation is common. Bi-atrial enlargement is common

7. Final Thoughts 7 For further information regarding this condition please refer to Dr. Braun’s Housecalls presentation of 6/26/12. The link to this presentation is: http://www.generaliusalifere.com/Publicati ons/Pages/Housecalls.aspx For further information regarding this condition please refer to Dr. Braun’s Housecalls presentation of 6/26/12. The link to this presentation is: http://www.generaliusalifere.com/Publicati ons/Pages/Housecalls.aspx This concludes this week’s ECG of the week. Contact me if you have questions!