Thick Heart, Wide QRS, Broad Differential

Stacey J Howell; Babak Nazer

doi:10.1016/j.jaccas.2021.06.021

Thick Heart, Wide QRS, Broad Differential

JACC Case Rep. 2021 Sep 1;3(11):1363-1366. doi: 10.1016/j.jaccas.2021.06.021.

Authors

Stacey J Howell¹, Babak Nazer²

Affiliations

¹ University of California-San Francisco, San Francisco, California, USA.
² Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.

Abstract

Routine electrocardiogram in a middle-aged man with left ventricular hypertrophy showed sinus rhythm, a short PR interval, and delta wave, confirming ventricular pre-excitation. Pre-excitation was fixed after a premature atrial complex and in atrial fibrillation, features diagnostic of a fasciculo-ventricular pathway. Genetic testing confirmed a diagnosis of hypertrophic cardiomyopathy. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; AP, accessory pathway; AVN, AV node; FVP, fasciculo-ventricular pathway; HCM, hypertrophic cardiomyopathy; LVH, left ventricular hypertrophy; PAC, premature atrial contraction; atrial fibrillation; cardiomyopathy; electrophysiology; genetic disorders; inherited metabolic disorders.