From the Research
Hypertrophic cardiomyopathy (HCM) can cause ST elevations, although this is not the most common ECG finding associated with the condition. The most recent and highest quality study, published in 2023 1, highlights the importance of distinguishing HCM-related ST elevations from those caused by acute coronary syndromes. HCM more typically presents with ST-segment depression, T-wave inversions, pathological Q waves, and left ventricular hypertrophy patterns on ECG. When ST elevations do occur in HCM, they are usually non-ischemic in nature and may be seen in precordial leads, particularly in cases with severe septal hypertrophy.
Key Considerations
- The mechanism behind these ST changes relates to the abnormal repolarization patterns caused by the asymmetric myocardial hypertrophy and potential microvascular dysfunction present in HCM.
- It's essential to correlate ECG findings with clinical presentation, cardiac biomarkers, and imaging studies like echocardiography to distinguish HCM-related ST elevations from those caused by acute coronary syndromes.
- The study published in 2023 1 provides ECG criteria to distinguish HCM featured with "Pseudo-STEMI" from acute ST-elevation myocardial infarction, which can help guide clinical decision-making.
Clinical Implications
- Clinicians should be aware of the potential for HCM to cause ST elevations and consider this diagnosis in patients with suspected acute coronary syndromes, especially if there are other signs of HCM on ECG or echocardiography.
- The management approaches for HCM-related ST elevations and acute coronary syndromes differ significantly, emphasizing the need for accurate diagnosis.
- Further research is needed to fully understand the relationship between HCM and ST elevations, but the current evidence suggests that HCM can cause ST elevations, and clinicians should be vigilant for this possibility.