You’re reviewing this ECG of a 19-year-old patient who presented to urgent care following transient loss of consciousness while exercising:
Which of the following concerning findings is present on the ECG? How will this finding direct your management of the patient?
A. Unusual T wave inversions consistent with Brugada syndrome
B. Dagger-like Q waves raising suspicion for hypertrophic cardiomyopathy
C. Epsilon waves concerning for arrhythmogenic right ventricle
D. No findings of concern are evident
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Answer: B. Hypertrophic cardiomyopathy (HCM) is an inherited structural cardiac disorder that is thought to be present in about 1 in 500 people; it is the most common cause of sudden cardiac death in young people. Left ventricular hypertrophy (most commonly asymmetric and involving the interventricular septum) can produce dynamic left ventricular outflow tract obstruction and predispose HCM patients to ventricular arrhythmias. Symptoms that should raise suspicion for HCM are exertional syncope or near syncope, palpitations, heart failure, and chest pain (frequently exertional or typical anginal pain).
Last Updated on January 26, 2023