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- W4300818198 abstract "A 79-year-old female patient diagnosed with hypertension and dyslipidemia had reported experiencing epigastric discomfort and palpitations for a week, but she denied having chest pain. Her admission electrocardiogram (ECG) is depicted in Figure 1. Her serum troponin I level was normal (<0.5 ng/mL). The patient underwent emergency coronary angiography for a presumptive diagnosis of ST-segment elevation myocardial infarction (STEMI) complicated by nonsustained ventricular tachycardia.What is your diagnosis?D) Hypertrophic cardiomyopathy with apical left ventricular aneurysmAn admission ECG (Fig. 1) showed STE with terminal T-wave inversion in leads II, aVF, III, V3 through V6, and subtle ST-segment depression in leads aVL and aVR, a pattern suggestive of spontaneously reperfused STEMI. Yet this ECG pattern remained unchanged from the prehospitalization ECG, making STEMI a doubtful diagnosis. The absence of PR-segment depression in leads with STE, the presence of ST-segment depression in lead aVL, and a low (<0.25) STE to T-wave amplitude ratio in V6 makes acute myopericarditis an unlikely diagnosis.1 Failure of pause-dependent augmentation of the terminal QRS notch/slur in V3 through V6 argues against early repolarization and suggests an intraventricular conduction delay–induced terminal QRS notching, giving rise to fragmented QRS complexes.2 An ECG pattern comprising STE with negative and/or biphasic T waves similar to the pattern presented herein may be observed in the subacute phase of takotsubo cardiomyopathy; yet, the absence of a positive T wave in lead aVR argues against such a diagnosis.3The electrocardiogram during tachyarrhythmia (Fig. 2) showed signs of ventricular tachycardia with origin from the left ventricular apex indicated by negative concordance (QS in leads V2–V6). Given the persistent STE and fragmented QRS in V3 through V6 that is a highly specific sign of LVA in patients with coronary artery disease, one could suspect an apical LVA.4 However, our patient had no history of myocardial infarction or deep Q waves in the same leads as those with STE. Therefore, the positive Sokolow-Lyon criterion SV1 + RV6 of at least 35 mm combined with persistent STE in the lateral precordial leads was suggestive of HCM with apical LVA.5 Left heart catheterization (Fig. 3 and supplemental motion image) and contrast echocardiography disclosed the absence of coronary artery disease and “mixed”-type apical HCM, with apical wall thickness of 20 mm, midventricular systolic pressure gradient of 12 mm Hg, and apical LVA. Our patient was discharged on metoprolol, amiodarone, and oral anticoagulation therapy after she had a dual-chamber implantable cardioverter-defibrillator placed." @default.
- W4300818198 created "2022-10-04" @default.
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- W4300818198 date "2022-09-01" @default.
- W4300818198 modified "2023-09-30" @default.
- W4300818198 title "Electrocardiographic ST-Segment Elevation and Nonsustained Ventricular Tachycardia in an Older Patient" @default.
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- W4300818198 doi "https://doi.org/10.14503/thij-21-7716" @default.
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