Abnormal electrocardiogram with signs of an old infero-lateral myocardial infarction scar. Hypertrophic cardiomyopathy has not one name

Abstract

We described a case of a 59-year-old woman without clinical significance. Abnormal resting electrocardiogram (ECG) was the cause of the cardiology consultation. The patient complained of the poor exercise tolerance for a year. The resting ECG showed: sinus rhythm 58/min, left axis deviation (QRS axis: 79^o), PQ interval: 108 ms, P wave axis: 77^o, QRS duration: 106 ms, QT/QTc interval: 452/450 ms. QS morphology in leads: II, III, aVF and V₅–V₆ with QRS (QS) fragmentation. The Q wave in lead V₄ with its duration of 20 ms, and amplitude of 2 mm. The poor progression of R wave in leads V2 and V₃. Positive, symmetric T waves in leads: II, III, aVF and V₅–V₅. Negative T wave in leads I and aVL. Increased S wave amplitude in leads: V₂ — 33 mm, V₃ — 29 mm. Positive QRS direction in lead aVR. What should be taken into consideration in differential diagnosis? 1) previous infero-lateral myocardial infarction; 2) myocardial hypertrophy; 3) possibility of preexcitation. Based on echocardiography hypertrophic cardiomyopathy was recognised with marked septum hypertrophy to 28 mm and with normal thickness of posterior wall (9 mm). The magnetic resonance of the heart confirmed the echocardiography findings.