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Normal ecgs, question.

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lgrass94 Find out more about lgrass94
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  • Normal ecgs, question.

    Hello guys,

    I have read a few posts here on ECG readings being normal with hocm or non obstruction.

    I must say, in the 10% of people that do have normal ecgs, the reason they still get diagnosed is because they have other heart failure signs. E.g swollen ankles, overweight, murmurs, and even coughs, or chesty.

    I always worried about it, but the fact is 1 in 500 is the estimation. 1 in 10,000 will have a severe case of thickening or dysfunction and finally if you have a normal ecg and no physical signs then it's even less likely then it already is.

  • #2
    Hello Igrass,
    I'm a little confused about your post.....You said you have a question but everything you have written is a statement....a lot of which I am not sure is actually true. Here is my current knowledge about the physiology of HCM and ECGs or EKGs. I am not a master of the statistics. In general, ECG is not used as a primary tool for diagnosing HCM for a good reason. ECG examines the overall electrical conduction through the heart at 12 different angles and HCM can be in place for years without necessarily causing an abnormal ECG. An ECG can show signs of ventricular hypertrophy, but that does not mean it is HCM. Ventricular hypertrophy can be caused by many things.
    Echo cardiogram with valsalva is the primary diagnostic tool for HCM....because it shows the structure and function of the heart. Part of an HCM work up might also be a cardiac MRI which shows scarring as well as thickness and motion abnormalities.
    Maybe your question is ....Is ECG a good screening tool for HCM? for instance, if we screen everybody with ECGs every year will we find HCM sooner....My understanding is the answer is no.
    Maybe your question is....Does an EKG show the true progression of HCM over time? No, it is not a reliable measure of progression.... Echocardiogram is the test to document progression.
    If you have a normal ECG and no symptoms ..... the only reason to do any further testing concerning HCM or risk for Sudden Cardiac Arrest would be if you had a positive family history for HCM or had positive genetic testing.
    I hope I have touched on the information you were looking for.
    Jill C
    After years of symptoms:
    Officially Diagnosed HOCM 2006
    Myectomy 3/11/13 at non-COE
    Extended Myectomy 7/23/14
    At Mayo with Dr. Joseph Dearani

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    • #3
      Hello JillC,

      Thanks for your reply,

      It was stemmed from a post on here that i came across one evening, a member was significantly concerned that it can be completely miss and hit on an ECG. Correct me if im wrong here, but its to my understanding that an enlargement cannot be present and NOT be seen on an ECG, one way or another! Weather that's concealed, withing normal range s and t depth's, then for sure you'd see t wave inversions, or st depression/elevations. The reason i say this is because you could imagine all the individuals with DCM ( which is more common as you know ) that have an ECG and dont get treated as there ECG is normal all the time. If it wasn't at least 70 or 80% foolproof then it wouldn't be used so frequently. Like you say, and ECG is a starting step, not a diagnostics tool. However i dont believe an enlarged heart CAN produce a typically normal ECG. There will be changes for sure, but some nurses, or dr's dont know what to look for

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      • #4
        "Enlargement" is a very general term.....A ventricle can be thickened without being enlarged. I believe having a cardiologist interpreting an EKG is the best way to get an accurate interpretation.... when in question a general cardiologist will take the EKG to an electrophysiologist. However, my points still stand. EKG is not the correct tool to screen for HCM. So yes, it is hit or miss to rely on an EKG for detailed information about HCM. That is not the fault of the doctor reading the EKG.....it's just the wrong tool for the job.
        Last edited by JillC; 05-02-2017, 12:49 AM.
        After years of symptoms:
        Officially Diagnosed HOCM 2006
        Myectomy 3/11/13 at non-COE
        Extended Myectomy 7/23/14
        At Mayo with Dr. Joseph Dearani

        Comment


        • #5
          yeah yeah, i get what you mean. its not a diagnostics tool, just a 'fault reader' as such of the heart. However whats not nice to see is when people get so afraid ( i used too ), that the ECG can be completely normal, normal t wave amplitudes, no inverts, no st depression, or pathological q waves. There's not a chance a hypertrophied heart can do that! I presume the E.P's job is to discover if hes looking at DCM, or HCM/HOCM or even tkotsubo ( broken heart ) syndrome. Otherwise we'd have all these patients with life threatening DCM, HOCM etc, but that don't get diagnosed due to the starting test being normal. I'm fortunate enough to know a lot about whats pathological, and even if not specific to HOCM! as you can probably tell. So i don't tend to worry as much once iv'e looked over my ECG's. Iv'e personally had an echo cardiogram aswell, back in 2015. The one thing that i would always worry about, was if having an echo cardiogram aged 20 ( that's how old i was ), is enough testing for the foreseeable future.

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