Peer Reviewed
ECG education

Is this familial hypertrophic cardiomyopathy?

Vivienne Miller
Abstract
Jamie is 19 years old. His older sister has recently been diagnosed with apical variant hypertrophic cardiomyopathy. Jamie is very fit and plays competition rugby every weekend. He and his mother present today because Jamie needs a referral to a cardiologist for further investigation as he has been told this condition is hereditary. His mother has already been tested and her ECG is normal. Jamie is taking no medication and has had no medical problems in the past. You arrange an ECG for Jamie before he sees the cardiologist.
Key Points
  • The T wave is normally upright in leads I, II and V3 to V6 and normally inverted in aVR and sometimes V1.
  • T waves are variable but usually upright in leads III, aVL, aVF and V2.
  • T waves are usually 1 to 5 mm in amplitude in leads I, II, and III and 2 to 10 mm in leads V1 to V6.
  • T-wave inversion in leads V1 to V3 is normal in children.
  • Generally, T-wave inversion over 2 mm in two or more adjacent leads requires further investigation.
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