2024 Volume 88 Issue 8 Pages 1345-
A 54-year-old man was referred because of an abnormal electrocardiogram (ECG) without symptoms recorded 5 years ago. It showed marked left ventricular hypertrophy (LVH) findings with giant negative T waves (GNT) (Figure A). Echocardiography had revealed LVH of 18-mm wall thickness, systolic anterior motion (SAM) with mild mitral regurgitation (MR), and LV outflow tract (LVOT) obstruction with a pressure gradient of 60 mmHg (Figure B). He had been followed as a case of hypertrophic obstructive cardiomyopathy (HOCM). On referral, he complained of shortness of breath and the ECG showed dynamic changes with reduction in LV voltage and disappearance of GNT (Figure C). Echocardiography revealed that the LV end-diastolic diameter (LVDd) had increased and maximum wall thickness had decreased (Figure D). Severe MR was observed due to new onset of prolapse with chordae tendineae rupture. SAM and LVOT obstruction were not observed. Mitral valve repair with a small amount of septal myocardial resection was performed. On the ECG recorded 1 week after surgery, GNT reappeared with LV high voltage (Figure E). Echocardiography revealed reduced LV size and increased LV wall thickness (Figure F).
Electrocardiogram showing dynamic changes of the left ventricular hypertrophy (LVH) findings, and parasternal long-axis echocardiograms showing changes of LVDd and LV wall thickness (A,B) 5 years ago, (C,D) index visit, and (E,F) 1 week after surgery for mitral regurgitation. IVSd, interventricular septal diameter; LVDd, left ventricular end-diastolic diameter; LVPWd, left ventricular posterior wall diameter.
There are various ECG findings in hypertrophic cardiomyopathy. Even if the ECG findings change, it generally does so slowly.1 However, dynamic ECG changes over a short period time can reflect structural changes in the LV chamber due to fluctuation in volume overload.
H.K. is a member of Circulation Journal’s Editorial Team. The remaining authors have no conflicts of interest.
