@dralvinazanib: ECG in Hypertrophic Obstructive Cardiomyopathy (HOCM) Classic voltage overload with repolarization abnormalities reflecting asymmetric septal hypertrophy. Key ECG Findings • Left ventricular hypertrophy (LVH) • High-voltage QRS complexes (tall R in V4–V6, deep S in V1–V3) • Deep, narrow (“dagger-like”) Q waves • Most prominent in inferior (II, III, aVF) and lateral (I, aVL, V5–V6) leads • Mimic prior MI but are narrow and without ischemic evolution • Repolarization abnormalities • ST depression and T-wave inversion, often asymmetric • “Giant” T-wave inversion may be seen (especially with apical involvement) • Left atrial enlargement • Broad/notched P waves due to diastolic dysfunction • Axis deviations • Commonly left axis deviation • Arrhythmias • Atrial fibrillation, atrial flutter; ventricular ectopy or NSVT may appear Helpful ECG Clues (Pearls) • Q waves are septal hypertrophy–related, not infarction (narrow, sharp). • LVH voltage is often out of proportion to symptoms or age. • Dynamic obstruction explains variability with preload/afterload changes. Differential Diagnosis (ECG Look-alikes) • Prior myocardial infarction – Q waves are broader, with regional ST-T changes • Hypertensive heart disease – LVH present but lacks classic narrow Q waves • Aortic stenosis – LVH with strain; clinical murmur/echo distinguishes • Athlete’s heart – High voltage without pathologic Q waves or strain pattern • Infiltrative cardiomyopathy (e.g., amyloidosis) – Often low voltage despite thick walls #ecg #cardiology #mbbs #paramedic #doctor

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Monday 09 February 2026 13:42:00 GMT