Persistent ST segment elevation: A new ECG finding in hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy is a primary disease of myocardium resulting in myocardial hypertrophy without any inciting pressure or volume overload. T he typical triad of symptoms includes exertional angina, syncope, and short ness of breath. Sudden cardiac death, the most dreadful complication of thi s disorder, can be the first manifestation of the disease and is more commo n in young patients. Elderly patients, on the other hand, may have a relati vely benign course with normal or near normal life span. The electrocardiog ram (ECG) and echocardiography are the two most useful measures to diagnose hypertrophic cardiomyopathy. The electrocardiographic features of hypertro phic cardiomyopathy are numerous, including ST segment elevation that may s imulate other ST segment elevation syndromes, including acute myocardial in farction, variant angina pectoria, acute pericarditis, bundle branch blocks , ventricular paced rhythm, dyskinetic ventricular segment, ventricular ane urysm, left ventricular hypertrophy, Wolff Parkinson White syndrome, and ea rly repolarization syndrome. This report describes a case of an asymptomati c patient who presented with ST segment elevation of acute injury type and, therefore, was admitted to rule out silent myocardial infarction. Myocardi al infarction was ruled out by cardiac enzyme levels, but ST segment elevat ion remained persistent in all of the subsequent ECGs. Echocardiography was performed, which clearly showed hypertrophic cardiomyopathy with left vent ricular outflow tract obstruction and a high intracavity pressure gradient. Subsequently, retrieval of old ECGs showed a similar type of ST segment el evation in the patient's previous ECGs. Copyright (C) 1999 by W.B. Saunders Company.