The conclusion to this case study has been combined with Part I.
Endurance athlete presents to EMS with syncope. Is the 12-lead ECG abnormal?
Have they done echo? This also looks like a variant of hypertrophic cardiomyopahty (apical variant or Yamaguchi syndorme). It would present as LVH with T wave inversions in precordial leads. Definitely not Brugada. Case # 14 of http://ecg.bidmc.harvard.edu/maven. Also http://www.med.harvard.edu/jpnm/tf99_00/june13/writeup.html.
I had a cardiologist tell me that a intracranial hemorrhage can cause ECG changes. I was wondering if any of those changes appear in this ECG?
I don’t know whether or not this patient has received an echo, but that’s one of the reasons I’m not comfortable assuming the LVH with strain pattern on the ECG is “normal” for this patient, even though he’s an endurance athlete.
Google “cerebral T-waves”. It’s a bit non-specific but I associate it with deep T-wave inversion and a prolonged QTc.
I have seen deep T wave inversions in a patient with an intracranial pathology (gioblastoma multiforme). That pt had been several admissions for AMS and lately I noted those changes. Others ecg change that I saw was AF with RVR in patient with embolic stroke with hemorrhgic transformation. Case 210 in this site http://ecg.bidmc.harvard.edu/maven will also show global T wave inversions. Also a very nice explanation for global T wave inversions.
Yes Tom I agree. LVH strain pattern too could not explain the T wave changes in the limb leads
He has hypertension? may be a hypertensive crysis.
Your email address will not be published. Required fields are marked *
Online 12-Lead ECG Course
Instructor Tom Bouthillet
12-Lead ECG Challenge Smartphone App – $5.99