Letters to the Editor
ECG Findings and Hypertrophic Cardiomyopathy
Am Fam Physician. 1998 May 1;57(9):2071-2078.
to the editor: It was great to see the excellent two-part series on common cardiovascular problems in the young.1,2 However, I disagree with the interpretation rendered for the electrocardiogram (ECG) shown in Figure 1 of the second article in this series.
The legend for this figure reads as follows: “ECG from a 12-year-old girl with hypertrophic cardiomyopathy. Note the presence of sinus rhythm and wide, bizarre QRS complexes. The recording is at half standard, so the complexes are actually twice as large as displayed. The ECG is abnormal in over 90 percent of patients with hypertrophic cardiomyopathy. The most common abnormalities are left ventricular hypertrophy, ST-segment alterations, T-wave inversion, large Q waves and the peculiar diminution of R waves in the lateral precordial leads seen in this patient.”
Close inspection of lead V1 in this tracing shows a short PR interval, slurring of the intial portion of the QRS complex (a delta wave) and QRS widening. Although delta waves are not well seen in many of the other leads in this tracing, I believe there is slurring of the initial part of the QRS in leads V4 and V5. In addition, the multiple deflections in the inferior leads may represent partially negative delta waves. I therefore believe that this ECG is highly suggestive of Wolff-Parkinson-White (WPW) syndrome.
While I fully agree that most patients with hypertrophic cardiomyopathy have an abnormal ECG, I do not feel that the tracing shown in Figure 1 is representative of what one should expect to find with this abnormality, other than the slight increased association of a familial form of WPW that is seen with hypertrophic cardiomyopathy.
1. Gutgesell HP, Barst RJ, Humes RA, Franklin WH, Shaddy RE. Common cardiovascular problems in the young: Part I. Murmurs, chest pain, syncope and irregular rhythms. Am Fam Physician. 1997;56:1825–30.
2. Gutgesell HP, Atkins DL, Day RW. Common cardiovascular problems in the young: Part II. Hypertension, hypercholesterolemia and preparticipation screening of athletes. Am Fam Physician. 1997;56:1993–8.
in reply: Dr. Grauer correctly points out that the ECG in Figure 1 of the second part of our review on common cardiovascular problems in the young appears to show preexcitation. The patient in question has marked septal hypertrophy and mild left ventricular outflow obstruction by echocardiography but has never complained of tachycardia. It illustrates our point that the ECG is almost always abnormal in hypertrophic cardiomyopathy, with preexcitation being one of the abnormalities that may occur.
Send letters to email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions