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You are seeing a 14 year old boy who presents with shortness of breath and chest pain while playing basketball. He has noticed it for the last few weeks, whenever he plays basketball. He has no significant past medical history, and he has not had a syncopal event. On exam, he has a 2/6 harsh systolic murmur best heard at the left lower sternal border. The murmur is louder with the Valsalva maneuver and softer when the patient goes from standing to squatting.
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July 21, 2022 at 11:18 am
D) Dagger Q waves in the lateral leads
ECGs are often used to screen for serious causes of sudden death in patients that present with symptoms such as syncope, dyspnea, and chest pain, particularly when they occur with exertion. Coved ST segment elevation is seen in Brugada syndrome, and the Epsilon wave is seen in arrhythmogenic right ventricular dysplasia; both of these more likely present with syncope than with a murmur. Delta waves are associated with Wolff-Parkinson-White syndrome, a pre-excitation syndrome due to an accessory pathway. WPW can lead to episodes of SVT and carries a small risk of sudden death. Hypertrophic obstructive cardiomyopathy (HOCM) presents with a systolic murmur, and the ECG may show left ventricular hypertrophy and dagger Q waves in the lateral leads. The murmur may be increased by standing up and the Valsalva maneuver, and decreased by sitting or squatting from standing, handgrip maneuver, and passive elevation of the legs.