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Need HCM criteria please!!!

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  • Need HCM criteria please!!!

    Hello everyone,

    Can anyone please provide me with a comprehensive list of the criteria used to determine/diagnose LV hypertrophy?

    I had an interesting day yesterday to say the least...
    I'm applying for life insurance and took all of the applicable tests (blood, urine, EKG, etc). Well, I get a call yesterday from my insurance agent who tells me that I cannot get the preferred rate due to my EKG showing "Left Ventricle Hypertrophy". As you can imagine, after reading all of the info on this condition it ruined my day and night...

    I immediately got on the phone with my doctor who tells me that their underwriter is just dead wrong. He's got years of EKG tests and a few different Echo tests that show me to be well within normal range for my age.

    So I'm scheduled for another Echo on Monday but I'd like to go into the appointment armed with as much knowledge and research as possible. My doctor started spewing a bunch of technical EKG jargon about upstroke plus downstroke, systolic, blah blah blah and I realized I'm the type of guy who needs to learn for my own piece of mind what all this stuff means.

    Thanks in advance for your help!!

  • #2
    Re: Need HCM criteria please!!!

    Please visit the main page of this website with all of the info. about HCM. I have copied the following from there:

    The main feature of hypertrophic cardiomyopathy is an excessive thickening of the heart muscle (hypertrophy literally means to thicken). Thickening is seen in the ventricular septal measurement (normal range .08-1.2mm), and in weight. In HCM, septal measurements may be in the range of 1.3mm to 6.0+mm. Heart muscle may also thicken in normal individuals as a result of high blood pressure or prolonged athletic training. Furthermore, there is a fine line between and athletic heart and a heart with HCM.
    Daughter of Father with HCM
    Diagnosed with HCM 1999.
    Full term pregnancy - Son born 11/01
    ICD implanted 2/03; generator replaced 2/2005 and 2/2012
    Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

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    • #3
      Re: Need HCM criteria please!!!

      Thanks for the info.

      So what criteria would the underwriter have used to determine LV hypertrophy have used from only looking at an EKG? I've been reading up on it but it's all hard core technical medical research jargon... T waves, Q waves...

      Is there a summary out there for diagnosing from an EKG? I'd like to have a detailed understanding of this so that when I sit down with my doctor on Monday I can go over my EKG and know what the ranges are, and where I fall in them.

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      • #4
        Re: Need HCM criteria please!!!

        An EKG is a highly unreliable way to diagnose HCM. The results of an EKG are read by a computer which uses some sort of programming to decide that your wave patterns are indicative of LVH. It is very unreliable, as I said, and no underwriter should be able to get away with using that to substantiate a definitive diagnosis. That should be pretty easy for you to fight and win assuming your echo is clean.

        By the way, I have no idea how to explain the way that the computer interprets the EKG. Again, highly highly technical. I am sure you could google "interpreting EKGs" or something, and find a better explanation, but as I stated, there is such a high margin of area in these computer interpretations that they can't be relied on.
        Daughter of Father with HCM
        Diagnosed with HCM 1999.
        Full term pregnancy - Son born 11/01
        ICD implanted 2/03; generator replaced 2/2005 and 2/2012
        Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

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        • #5
          Re: Need HCM criteria please!!!

          You should have your doctor write a letter and include your prior ecgs and echo results to the underwriter. an ecg is NOT the test that anyone uses to diagnose HCM. it can't --the key thing is the hypertrophy and that is only visible on an echo or a heart MRI.

          good luck!
          S

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          • #6
            Re: Need HCM criteria please!!!

            Mr. Art Vandelay,

            I am echoing what they have said about the testing. One of the best ways to determine if you have HCM is with an echo of your heart.

            I will say this... when I went to do the same thing; get more life insurance, they sniffed out my problem before my doc did. I'm not saying they're right but I would push to have an echo done.

            P.S. cool screen name. LOL


            Dewayne

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            • #7
              Re: Need HCM criteria please!!!

              I wanted to address the EKG issue again. When a heart has been damaged and some of the tissue has been oxygen starved, the EKG changes. My mom's EKGs print up with the words "possible heart attack" (or whatever the doctor-version of that is) on it every time because of the HCM. But she's never had a heart attack. I've even had a machine say I had an episode of ventricular tachycardia --a potentially fatal irregularity-- but I had NOT. It was a combination of my moving and a lead falling off at the same time.

              When I was sixteen, my T wave became inverted, and this happens a lot to HCMers. So the T squiggle on the print out goes down instead of up--at the end of a heart beat, when the heart should be positively charged, it is negatively charged instead. But inverted T waves can be caused by many things, not just HCM...which is part of why you can't diagnose HCM from an EKG.

              Here is a link to great instructions on how to read an ecg and what all the letters mean. http://students.med.nyu.edu/erclub/ekgexpl0.html

              Good luck,

              S

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              • #8
                Re: Need HCM criteria please!!!

                Hi all, Thanks for all the useful info. Below is what I was looking for:

                ECG criteria for LVH
                There are multiple criteria used to diagnose LVH via electrocardiography.
                None of them are perfect. However, by using multiple different criteria the sensitivity and specificity are increased.

                The Cornell criteria1 for the ECG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead V3. The Cornell criteria for LVH are:

                S in V3 + R in aVL > 28 mm (men)
                S in V3 + R in aVL > 20 mm (women)
                Other voltage-based criteria for LVH include:

                Lead I: R wave > 14 mm
                Lead aVR: S wave > 15 mm
                Lead aVL: R wave > 12 mm
                Lead aVF: R wave > 21 mm
                Lead V5: R wave > 26 mm
                Lead V6: R wave > 20 mm


                From talking to my doctor, the above criteria is very broad and would still need to be adjusted for the patient's age.

                By the way, the Echo this morning came back well within the normal ranges so no HCM worries for me!! I'll probably go for a second opinion but my cardiologist said most likely we'll find out the the underwriter simply made a mistake when reading the EKG.

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                • #9
                  Re: Need HCM criteria please!!!

                  Can't help you much with the information you're looking for, but I just gotta say that I'm a huge fan of Seinfeld and your screen-name always gives me a nice chuckle. Perhaps you can email/call the HCMA office and get reference material for the info you need.
                  "Some days you're the dog... some days you're the hydrant."

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                  • #10
                    Re: Need HCM criteria please!!!

                    Mr. Vandelay,

                    I indeed hope it was all a poor interpretation. Are you an architect?... or are you simply an importer / exporter… I forget!

                    Sincerely,

                    H.E. Pennypacker

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