• Cardiomyopathy
• Sudden Death in Athletes
• ECG and Hypertrophic Cardiomyopathy

Cardiomyopathy

• Cardiomyopathy (CMP) is a group of diseases that primarily affect the myocardium
  
  
• Hypertrophic Cardiomyopathy (HCM)
• Occurrence is about 1 in 500 people, it is one of the most common congenital heart diseases
• It involves inadequate hypertrophy of the myocardium, most often of the left ventricle
• Hypertrophy does not have a hemodynamic cause (high pressure, aortic stenosis)
• Physiologically, the left ventricle has a thickness up to 12mm
• In HCM, it can reach up to 60mm
• HCM most commonly has 2 variants:
• Asymmetric hypertrophy of the ventricular septum
• Apical hypertrophy (Hypertrophy of the apex)
• The hypertrophied wall is an arrhythmogenic substrate
  • There is a risk of malignant ventricular arrhythmias
  • Arrhythmias are often triggered by physical exertion
• 50% of HCM cases have a genetic predisposition
• Approximately 150 gene mutations associated with HCM are known
• Sometimes referred to as hypertrophic obstructive CMP (HOCM)
• However, 75% of HCM does not cause obstruction of the left ventricular outflow tract

ECG and Hypertrophic Cardiomyopathy

• Hypertrophic Cardiomyopathy (HCM) does not have specific ECG diagnostic criteria
• ECG in HCM is always abnormal
• Diagnosis is based on echocardiography
  
  
• Most common ECG changes in hypertrophic cardiomyopathy
• Left Ventricular Hypertrophy (and non-specific ST and T wave changes)
• Right Ventricular Hypertrophy
• P mitrale (Left Atrial Hypertrophy) (due to diastolic dysfunction of the left ventricle in HCM)
• P pulmonale (Right Atrial Hypertrophy)
• Pathological Q wave (caused by hypertrophy of the ventricular septum)
• Located in lateral leads (I, aVL, V5-V6) and inferior leads (II, III, aVF)
• Usually width < 40ms (not always the case)
• Q wave can mimic a previous myocardial infarction
• Q wave after infarction has a width > 40ms
• WPW Syndrome (33% of HCM patients have WPW syndrome)
• Genetic mutations often cause both conditions simultaneously
• Deep negative T waves (V2-V6)
• Occur in apical HCM
• However, this apical HCM is very rare
• It mainly occurs in Japan, affecting about 20% of HCM patients
• Ventricular Tachycardia
• Ventricular Extrasystoles

Apical Hypertrophic Cardiomyopathy

• Left Ventricular Hypertrophy
• Sokolow index > 35mm
• Deep negative T waves (V2-V6)
• Indicate apical HCM
• Similar deep - cerebral T waves can also occur in intracranial hypertension
• Patient had hypertrophic cardiomyopathy on echocardiography

Septal Hypertrophic Cardiomyopathy

• Left Ventricular Hypertrophy
• Sokolow index > 35mm
• Pathological Q Wave
• Wide < 40ms, in lateral leads (I, aVL, V5-V6)
• The patient had hypertrophic cardiomyopathy on echocardiography

Apical Hypertrophic Cardiomyopathy

• Left Ventricular Hypertrophy
• Sokolow index > 35mm
• P Mitrale (Left Atrial Hypertrophy)
• Double-peaked P wave (Lead II)
• Deep Negative T Waves (V2-V5)
• Indicates apical HCM
• Similar deep T waves can also occur in intracranial hypertension
• The patient had hypertrophic cardiomyopathy on echocardiography