abnormal ECG/normal Echo

[Abbygirl2]

I was reading an article and came across the following....

"... it is important to recognise that the ECG may be abnormal in HCM when echocardiography reveals no evidence of left ventricular hypertrophy."

I am just wondering how common this is, and HOW can one possibly get a diagnosis of HCM with just an abnormal ECG? I thought the key factor in diagnosing HCM was LVH?

My mom has had an abnormal EKG for over 20 yrs(shows previous heart attack-same as mine), yet her echos always come out normal.

Just curious.

Pam

[shirleymahoney]

Abby

My dads does the same thing yet no hypertrophy when he has an Echo and my younger brother the same way, i find it weird too, they say my dad doesn't have the disease but i know it came from his side of the family because the only thing my half brother and i have in common is our dad we have different mothers and my half brother died 17 years ago from then IHSS so i figure it has to be our father Go Figure

Shirley

P.s but as they say you can pass it on without having the disease itself you just need the gene to pass it on

[Reenie]

There may be other things that aren't as readily visible on an echo that can indicate HCM. One is that the heart beats more stongly than necessarily, called hyperdynamic. Another issue is how well the heart relaxes between beats. An HCM heart has a hard time relaxing to fill with blood. This is also more difficult to see on echo. That doesn't mean the person doesn't have the gene or have a degree of HCM. I sure hope my rambling made sense!

Reenie

[Julie E]

abnormal ecg

My 12 year old has had an abnormal ECG since I first had him checked at age 5 after being diagnosed myself.

He has what the EP at Cinti Children's call a "flipped T wave". His echo's have all been normal to this point.

The doctor said this in itself does not mean he has HCM, BUT you tend to see it in HCM. He also stated this may just be the way he is and we know he has had this from the first ECG ever done . So we will continue to watch him. He is checking him every 2 years right now unless something changes.

I also have an abnormal ECG now..but I was not diagnosed until age 35 after losing my brother. I had an echo and a few ECG's at around age 24 because I was having a lot of fluttering. They diagnosed me with mitral valve prolapse. Obviously my heart changed in that 11 year span of time or else I had really incompetent doctors who did not see an abnormal ECG or a thickened echo. I hope that is not the case. Unfortunately those echos are long gone.

Julie in Cincy

[Abbygirl2]

Thanks all for the replies.
My 4 yr old has an abnormal ECG as well, but so far no diagnosis of HCM (thank goodness). I will have to learn a LOT more about ECG's I guess.

With any luck we will be able to make it to the annual meeting this year.

Take care all.

Pam

[Debbie]

There may be other things that aren't as readily visible on an echo that can indicate HCM. One is that the heart beats more stongly than necessarily, called hyperdynamic. Another issue is how well the heart relaxes between beats. An HCM heart has a hard time relaxing to fill with blood. This is also more difficult to see on echo. That doesn't mean the person doesn't have the gene or have a degree of HCM. I sure hope my rambling made sense!

Reenie

Gosh, this sounds just like my daughter. She has seen a pediatric cardiologist every two years since she was 11. She will be 18 at the end of March. I got her in to see my cardiologist a couple of weeks ago, and just Monday, she did a stress echo.

When she first saw my cardiologist, he said that her EKG was abnormal, and that her pediactric cardiologist must have different standards than him for a normal EKG, since her EKG hadn't changed. But the pediatric cardiologist had said that her EKG was normal.

Also, she has been presenting some symtoms of HCM lately. She has pronounced heartbeats, and some palpitations. Also, she gets dizzy many times when she stands up from sitting, just like me.

Anyway, her stress test proved normal, thank God. My cardiologist said that she is a healthy young woman, and that she can have another exam in 5 years.

Oh, and when he was looking at her echo before the stress test, he said, "boy, with these measurements, she would be hyperdynamic", to the tech. He also told me that her heart is very vigorous, but that is ok for a 17 year-old.

What do you think?

Debbie

[Lisa Salberg]

These are questions that need to be answered. If you have genetics on the kids I would highly suspect that an HCM specialist may well diagnose them based on the abnomal ECG. The majority of docs want to see the 'classic' echo findings prior to making the call that it is in fact HCM. I for one and not sure that is the right thing to do with these young ones.

More research is needed and hopefully time will tell us what is that best path to follow.

Best wishes,
Lisa

[Laoshur]

This thread sort of raises a question that I have been wondering about lately:
Since LVH is the clear test of HCM and since hypertrophy of a muscle must take time to develop, isn't it entirely possible for people to have symptoms and HCM before the hypertrophy becomes apparent? How long can this process take and what is the risk to people in this pre-apparent stage?

Rhoda

[Brownie]

Hi everyone:

I can't answer your question regarding risk, Rhoda, but I can say that Olivia's pediatric cardiologist detected an abnormality in her ECG ten years prior to her diagnosis. I suspect, however, that her diagnosis was delayed because she had no echos done during that time. Her septum was 3.3 centimeters at diagnosis, and would have taken time to get that large. His initial interpretation of the anomoly was that a second electrical pathway might have been developing.

By the way, Rhoda, how are you feeling these days?

Abby

[Reenie]

I think some do have symptoms before the hypertrophy appears.

Reenie

[Pam Alexson]

My symptoms went back to 7 years of increasing severity from age 40. As a teenager I passed out a lot up to and including my early 40ties. I was diagnosed at age 18 with a loud systolic ejection murmur. In my early forties I was told I had a hyperdynamic left ventricle and the label LVH started showing up on my paper work after my first echo at age 42. At age 47 I personnally diagnosed myself with HCM and had a specialist confirm it, because my local cardiologist said I was wrong . My confirmation by a specialist left my local cardiologist to say only, " this just happened."

As we are all now enlightened , we know that HCM ( obstructed and with CHF) does not "just happen", right?

I am sure that I was that doctors worst nightmare and he probably sleeps a lot better never having to face me anymore. I know that he ducts around in the local hospital if he learns any of his consults are related to me. I have been told he quickly refers them out. Gee now what could be the problem?

Pam

[Julie E]

diagnosis based on ecg only

This is a tough one as far as diagnosis with ecg only.

If you have a child(as I do) who has an abnormal ecg but echo is normal and they present with NO symptoms do you really want a HCM diagnosis without concrete testing? You are setting up for a whole different set of problems that is hard to reverse should the diagnosis never be substantiated with an echo etc.

Labeling a child HCM with only an abnormal ecg?? Not sure I would go that route. I will be the first to protect my 12 year old if the testing proves the diagnosis but I'm not so sure on ecg only???

I guess my question is can SCD occur with an abnormal ECG but no thickening of the septum. I was under the impression that part of the problem is that the electrical system goes out of whack due to the thickening and it has to work it's way around the thickened septum therefore causing v fib, a fib etc. If you do not have this thickening are you still at risk for SCD?

Julie

[Pam Alexson]

Many individuals have minimal in comparison to others degree of thickenining of the septum. The septum can be say 15 mm and still a person can have SCD. The dissaray of the myocardial cells appear to have a good deal of influence here. So, yes even with a less thickened septum SCD can occur. A thickened septum , an obstructed Hcm does not appear to directly make an individual more prone to SCD. When the individuals heart rate is high this does appear to have a more direct influence on SCD. Increased rate and the dissaray of the cells can lead to an arrythmia that can lead to V- fib. Does this make sense?


There are some variables here . Many individuals have an abnormal EKG and can demonstrate a normal ECHO. Important also is how well trained the echocardiographer is . My EKg's were off for years and explained away . When I was young the doctor told my mother I was anemic and he used the same to explain away my loud murmur.

Specialists are very important here.

Pam

[Tigger1]

I have 3 daughters, 19, 16 and 16. They were tested last summer after my septal myectomy. They all tested neg. for hcm. My question is when should they be tested again and what are the best tests to have done.

By the way, I go back to Cleveland in May for my 1 year exam. Does anybody know what if any tests I can expect to have done.


Tigger1

[Pam Alexson]

Hi Tigger,

My kids are 18, 24 and 25. They were tested( echo and EKG's), when I was first diagnosed and then 3 years later . The 25 year old is set for the next 5 years and the other 2 every three until they reach 25 , then every 5.

For your anual probably an echo and an EKG and a visit to the clinic. Others may offer input as I go to Boston.

Pam