Syncope with High Voltage: The Yamaguchi Pattern
ECG Weekly Workout with Dr. Amal Mattu
HPI
52-year-old man with PMHx of hypertension presents after a witnessed syncopal episode at home. He felt lightheaded while standing to use the bathroom and briefly lost consciousness without seizure activity or trauma. On arrival he is alert and reports residual dizziness but no chest pain or dyspnea. No prior syncope, stimulant use, and no family history of sudden death is known. There is no other known past medical history or significant family history. Vitals and physical exam is unremarkable without focal neurological deficits or murmurs. The following ECG is obtained on arrival:
Before watching this week’s workout, review the ECG and consider:
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- What specific ECG findings would raise concern for Yamaguchi (apical) hypertrophic cardiomyopathy, and what are the key differentials for those findings in patients with syncope?
- Based on the history and ECG, what are your immediate concerns and disposition priorities? What tests would you obtain in the ED to risk stratify syncope in suspected apical HCM?
- What is the most appropriate next imaging study to confirm the suspected diagnosis, and what counseling or follow-up should be arranged for the patient and first-degree relatives?
