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On May 2000, a 67 year old woman was admitted to the hospital because of right upper eyelid ptosis. She was normotensive and had never experienced chest pain, dyspnoea or other symptoms suggestive of heart disease. A routine 12 lead ECG (upper panel, A) revealed an ST segment elevation with associated negative T waves in several leads, suggesting a possible acute myocardial infarction. Physical examination did not reveal any abnormal heart finding, and cardiac enzymes were negative. Echocardiography (lower panels A and B: LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle) revealed a pronounced and generalised left ventricular hypertrophy with normal wall motion and absence of gradient across the left ventricular outflow tract. Several ECGs obtained in the following days were unchanged. The coronary angiogram showed normal coronary arteries. Accordingly, the apparent acute myocardial infarction pattern was likely to be dependent on hypertrophic cardiomyopathy. The patient was followed up and no changes in the ECG pattern were observed in the ensuing three years (upper panel, B).
This case shows that hypertrophic cardiomyopathy can be associated with an ECG falsely suggesting an acute myocardial infarction.
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