From the Research
The patient's ECG and echocardiogram findings suggest early cardiac dysfunction, warranting further evaluation with a comprehensive cardiac workup, including cardiac MRI, 24-hour Holter monitoring, and possibly genetic testing for cardiomyopathies. The combination of left axis deviation, first-degree AV block, borderline ejection fraction (54%), and reduced global longitudinal strain (GLS) of 14.4% raises concern for an underlying cardiomyopathy, particularly early hypertrophic cardiomyopathy or other infiltrative processes 1. The patient should be referred to a cardiologist for management. While no immediate medications are required based solely on these findings, the cardiologist may consider beta-blockers if symptoms are present. The reduced GLS is particularly significant as it often detects subclinical myocardial dysfunction before ejection fraction declines. First-degree AV block combined with left axis deviation suggests conduction system disease that could progress over time. Regular follow-up with serial echocardiograms every 6-12 months is advisable to monitor for disease progression, as echocardiography provides valuable information on LV function and dimensions that exceeds that obtained by clinical examination and ECG 2. The patient should also be counseled about reporting any symptoms such as exertional dyspnea, chest pain, palpitations, or syncope promptly.
Some key points to consider in the management of this patient include:
- The importance of echocardiography in assessing LV function and dimensions, as it provides information that vastly exceeds that obtained by clinical examination and ECG 2
- The potential for underlying cardiomyopathy, such as hypertrophic cardiomyopathy, and the need for further evaluation with cardiac MRI and genetic testing 1
- The significance of reduced GLS in detecting subclinical myocardial dysfunction before ejection fraction declines
- The need for regular follow-up with serial echocardiograms to monitor for disease progression
- The importance of counseling the patient to report any symptoms promptly, such as exertional dyspnea, chest pain, palpitations, or syncope.
It is also important to note that electrocardiographic features, such as T-end-P/(PQ*age) and repolarization times, may have diagnostic potential in identifying left ventricular diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction (HFpEF) 1. However, these features are not widely evaluated in diagnostic studies, and further research is needed to fully understand their significance.