Medical Case: Diagnosis of Apical Hypertrophic Cardiomyopathy VT with WCT Analysis
A middle-aged man experienced chest discomfort and palpitations during routine exercise, lasting over an hour before contacting EMS. The initial electrocardiogram showed regular wide QRS tachycardia (WCT) at a rate of approximately 230 bpm, with no significant atrial activity. Based on experience, regular WCT without P waves in middle-aged men with new symptoms indicates a probability of ventricular tachycardia (VT) of at least 80 - 90%. Further observation of QRS morphology revealed extreme axis deviation, with positive QRS in lead aVR, fully negative QRS in lead V6, no biphasic waves in chest leads, and QRS being amorphous, which leads to a comprehensive judgment that the probability of this regular WCT being VT is >98 - 99%. The patient's hemodynamics were stable, and an attempt at intravenous amiodarone was unsuccessful, followed by cardioversion to restore sinus rhythm. After cardioversion, the electrocardiogram showed ST-T wave abnormalities. Analysis combined with the patient's medical history, disappearance of symptoms, and echocardiographic findings of apical hypertrophy suggested that the primary issue was likely severe apical cardiomyopathy, with VT originating from the left ventricular apex, consistent with echocardiographic findings. Subsequent examinations (CT coronary angiography showed no obstructive disease, cardiac MRI consistent with severe apical hypertrophy) also confirmed this diagnosis.
