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Post by pbruss on Apr 26, 2015 13:03:54 GMT -5
20 yo male with syncope. no sumptoms before or after. he has had episodes of syncope 4-6 times a month. all the same. denies any symptoms in the ED. hos BP is ok his HR is in the 40s and agin has no symp in the er. he does have a 2/6 holosystolic murmer. denies any drugs or family history. attached is his ecg. what do you think Attachments:
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Post by kemple on Apr 26, 2015 13:21:53 GMT -5
HOCM
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Post by pbruss on Apr 27, 2015 11:08:47 GMT -5
this ekg does not fit with HOCM but the history is very concerning. attached is an EKG for HOCM. turms out this kid had a bicuspid aortic valvue with severs stenosis. honestly i did not come up with the diagnosis from the ecg alone. the LVH with strain in the primordial leads could be a result of years of a bad valve but i dont think it is pathoneumonic for the diagnostic. but the history and physical and that LVH with strain is concerning and should warrant further testing and treatment Attachments:
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Post by tyson on Apr 27, 2015 14:58:22 GMT -5
hocm also usually has tall R-waves and dart-like q waves in addition to what was said above.
however, with the case and history you gave, hate to miss a subtle HOCM, just bc ECG doesn't fit perfectly. the LVH is more than enough to earn an ECHO in this young pup.
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