Symptomatic adolescent with non-obstructive asymmetric hypertrophic cardiomyopathy

Dr. Raimundo Barbosa Barros
Brazil

Case comunication

Adolescent, male, Caucasian, 16 years old, with rare complaints of rapid palpitations and concomitant precordial pain.
The patient had, on two occasions, sustained (with hemodynamic stability in 2014) and unstable in 2017. On the first occasion, was performed ablative treatment in the same year 2014. Deny syncope or recovered cardiac arrest. On treatment with amiodarone.
Physical examination (out of the crisis). Weight: 50kg , High: 1.70m,
CV: discrete systolic murmur of mitral insufficiency and fourth sound. Rest nothing worth noting.
Transthoracic echocardiogram: shows non obstructive asymmetric hypertrophic cardiomyopathy, with predominance of the posterior wall.
No genetic study and no nuclear magnetic resonance (MRI) yet.
* Definition of Stable Tachycardia For a diagnosis of stable tachycardia, the patient meets the following criteria:
The patient’s heart rate ≥100 bpm.
The patient does not have any serious signs or symptoms as a result of the increased heart rate.

Questions:

What is the electrocardiographic diagnosis of the events?
What is the baseline ECG diagnosis?
What is the electrophysiological substrate and why?

Comunicação de caso

Adolescente do masculino, Caucasiano, 16 anos, com raras queixas de palpitações rápidas e concomitante dor precordial.
O paciente teve por duas vezes eventos de taquicardia irregular rápida (registrados em 20014 e 2017), de complexos largos, e com estabilidade hemodinâmica#, (2014 e 2017). Na primeira ocasião, realizara tratamento ablativo no mesmo ano 2014). Nega síncope ou parada cardíaca recuperada. Em tratamento com amiodarona. Exame físico (fora da crise) sopro sistólico discreto de insuficiência mitral e quarta bulha. Resto nada digno de nota.
O ecocardiograma transtorácico: cardiomiopatia hipertrófica assimétrica não obstrutiva a predomínio da parede posterior