Pérez-Riera Andrés Ricardo, de Lucca Augusto Armando, Barbosa-Barros Raimundo, Yanowitz Frank G, de Cano Silvia Fortunato, Cano Manuel Nicolás, Palandri-Chagas Antônio Carlos
Cardiology Discipline, ABC Faculty of Medicine, ABC Foundation, Santo André, São Paulo, Brazil.
Ann Noninvasive Electrocardiol. 2013 Jul;18(4):311-26. doi: 10.1111/anec.12067.
The electrocardiogram is an important tool for the initial diagnostic suspicion of hypertrophic cardiomyopathy in any of its forms, both in symptomatic and in asymptomatic patients because it is altered in more than 90 percent of the cases. Electrocardiographic anomalies are more common in patients carriers of manifest hypertrophic cardiomyopathy and the electrocardiogram alterations are earlier and more sensitive than the increase in left ventricular wall thickness detected by the echocardiogram. Nevertheless, despite being the leading cause of sudden death among young competitive athletes there is no consensus over the need to include the method in the pre-participation screening. In apical hypertrophic cardiomyopathy the electrocardiographic hallmarks are the giant negative T waves in anterior precordial leads. In the vectorcardiogram, the QRS loop is located predominantly in the left anterior quadrant and T loop in the opposite right posterior quadrant, which justifies the deeply negative T waves recorded. The method allows estimating the left ventricular mass because it relates to the maximal spatial vector voltage of the left ventricle in the QRS loop. The recording on electrocardiogram or Holter monitoring of nonsustained monomorphic ventricular tachycardia in patients with syncope, recurrent syncope in young patient, hypotension induced by strain, bradyarrhythmia, or concealed conduction are markers of poor prognosis. The presence of rare sustained ventricular tachycardia is observed in mid-septal obstructive HCM with apical aneurysm. The presence of complete right bundle branch block pattern is frequent after the percutaneous treatment and complete left bundle branch block is the rule after myectomy.
心电图是初步诊断各种类型肥厚型心肌病的重要工具，无论是有症状还是无症状的患者，因为在超过90%的病例中它都会出现改变。心电图异常在显性肥厚型心肌病患者中更为常见，而且心电图改变比超声心动图检测到的左心室壁厚度增加更早、更敏感。然而，尽管肥厚型心肌病是年轻竞技运动员猝死的主要原因，但对于是否有必要将该检查方法纳入赛前筛查，目前尚无共识。在肥厚型心肌病中，心电图的特征性表现是胸前导联出现巨大倒置T波。在向量心电图中，QRS环主要位于左前象限，T环位于相反的右后象限，这就解释了记录到的T波深倒置的原因。该方法可以估算左心室质量，因为它与QRS环中左心室的最大空间向量电压有关。在晕厥患者、年轻患者反复晕厥、用力诱发低血压、缓慢性心律失常或隐匿性传导患者中，心电图或动态心电图监测记录到非持续性单形性室性心动过速是预后不良的标志。在伴有心尖部动脉瘤的中隔梗阻性肥厚型心肌病中可观察到罕见的持续性室性心动过速。经皮治疗后常出现完全性右束支传导阻滞图形，而心肌切除术后则以完全性左束支传导阻滞为主。
