Nelson’s ECG review March 2015

  1. Apical hypertrophy (Yamaguchi syndrome) can mimic wellen’s syndrome.

    Wellens’ syndrome should not be diagnosed in the presence of LVH.
  2. HOCM can mimic anterolateral MI by producing deep (“dagger like”) Q wave
    – Q wave in MI should be at least >40 ms width, but HOCM Q wave typicall is <40 ms.
    – Pathogenesis is septal hypertrophy can prolong the initial L-R depolarization in the septum, causing deep Q waves in lateral leads.
    Compare with MI
  3. LAHB may cause posteriorly directed force (by left posterior fascicle) resulting in q wave in V1-V3 (anterior precordial leads), mimicking MI.
    Picture1
    From Nelson’s ECG http://www.nelsonsekgsite.com/current/March%202015%20NNA%20scans-3021-3026.pptx

Bottom line in this month:

  • LAHB, HOCM and apical hypertrophy may mimic infarction, beware !
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