Casos

An entity where ECG/VCG are “gold standard” for the diagnosis

Dr. Andrés R. Pérez Riera
Dr. Andrés R. Pérez Riera
Brazil

Case presentation

Caucasian male, 34 years of age, with history of chest pain and exhaustion in strain.
Personal antecedents: He mentions systemic hypertension without treatment currently. He doesn’t smoke or have diabetes.
Family background: His father died with 77 years of age due to AMI? His brother died suddenly when he was 37 y.o. in his sleep.
Physical: Cardiac auscultation: regular heart rhythm; HR=68 bpm + fourth heart sound without murmur
Normal pulmonary artery and limbs
BP=140/100 mmHg
After the ECG/VCG were performed (annex) we suggested performing Echo to rule out apical hypertrophic cardiomyopathy.
Echo: LV end diastolic diameter: 49 mm. LV end systolic diameter: 26 mm. Septal diastolic thickness: 14 mm. LV posterior wall diastolic diameter: 14 mm. Aorta: 29 mm; LA: 40 mm EF=78% Mass: 355 g
Conclusion: moderate LV concentric hypertrophy. Moderate LV diastolic dysfunction. Heart valves with normal morphological aspect. Absence of gradient in the LVOT. Mild mitral reflux.
Supplementary tests
Several ECGs with the same morphology.
Holter monitoring: Sinus rhythm predominates Asymptomatic isolated premature ventricular contractions (PVCs) (210)
Absence of NSVT. We performed cardiac catheterization.

Questions:

  1. Which is the most probable clinical diagnosis?
  2. Which is the ECG/VCG diagnosis?
  3. Which is the differential diagnosis?
  4. Which is the prognosis?

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Auspicios Institucionales
  • Sociedad Argentina de Cardiología
  • Federación Argentina de Cardiología
  • SIAC
  • SADEC
  • Asociación Argentina de Cardiología
  • Latin American Heart Rhythm Society
  • Fundación Barceló - Facultad de Medicina