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The patient was referred for an exercise nuclear study and did 11 min on the Bruce protocol without angina or ischaemic ECG changes. A transthoracic echocardiogram was performed ( figure 1 ). Figure 1 Transthoracic echocardiogram ((A) apical four-chamber view; (B) parasternal short-axis view).
The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). This is "Persistent ST elevation after previous MI" or "LV aneurysm morphology". LV aneurysm is very different for inferior vs. anterior MI. Transient ST elevation is very hazardous.
No further echocardiograms were available after cath. The full thickness infarction with LV aneurysm morphology places him at a higher risk for short and long term complications (e.g., Free wall rupture, VSD, Dresslers Syndrome, chronic CHF, anatomic LV aneurysm, LV thrombus, stroke, etc). Teaching points: 1.
Angina is another common symptom due the hypertrophy which causes a coronary supply demand mismatch Symptoms of HCM include syncope/near syncope, which could be precipitated by exertion, hypovolemia, rapid standing, Valsalva manoeuvre, diuretics, vasodilators or arrhythmia. Doppler echo showing LVOT gradient in HCM.
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