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Tuesday 28 July 2026 11:39:02 GMT
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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
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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