Chest, Vol 75, 167-173, Copyright © 1979 by American College of Chest Physicians

ARTICLES

The electrocardiogram in asymmetric septal hypertropy

RL Engler, P Smith, M LeWinter, B Gosink and A Johnson

Electrocardiograms and echocardiograms in 44 patients with asymmetric septal hypertrophy were reviewed. Patients with asymmetric septal hypertrophy had incidences of left ventricular hypertrophy (33 percent; 16/44) and left atrial hypertrophy (25 percent; 11/44) by ECG that were less than in a group of patients with significant aortic stenosis (70 percent [31/44] and 64 percent [28/44], respectively). Left ventricular hypertrophy on the ECG was associated with a greater septal-posterior wall thickness ratio in asymmetric septal hypertrophy. A small Q wave in lead V4 or a ratio of the R-wave to the S-wave amplitude (R/S ratio) of greater than 0.20 in lead V1 was found in 14 of 44 patients with asymmetric septal hypertrophy but in no patients with aortic stenosis. The mean corrected Q-T interval (Q-Tc) of patients with asymmetric septal hypertrophy was prolonged, and the mean Q-Tc of patients with aortic stenosis was normal. The distinctive findings of an R/S ratio of more than 0.2 in lead V1 and Q waves in lead V4 in asymmetric septal hypertrophy have clinical significance, and the prolonged Q-T interval may relate to sudden death.

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