Hypertrophic Cardiomyopathy LVH Deep Q-Waves MCQ — NEET PG Practice Question | NEETPGAI
Hypertrophic Cardiomyopathy LVH Deep Q-Waves
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stethoscope Medicine
A 28-year-old male athlete presents to the cardiology clinic for screening after his 32-year-old brother suffered sudden cardiac death during a football match. On examination, a harsh crescendo-decrescendo systolic murmur is heard at the left sternal border that increases with Valsalva maneuver. His 12-lead ECG is shown in the diagram. The pattern marked **A** — showing left ventricular hypertrophy with deep narrow inferolateral Q-waves and T-wave inversions — is characteristic of which condition?
A. Acute myocardial infarction with inferolateral wall involvement
B. Hypertrophic cardiomyopathy caused by sarcomeric protein mutations
C. Dilated cardiomyopathy with secondary ischemic changes
Restrictive cardiomyopathy with amyloid infiltration
D.
Explanation
Why Hypertrophic cardiomyopathy caused by sarcomeric protein mutations is right
The ECG pattern marked A — deep narrow (pseudo-infarction) Q-waves in the inferolateral leads (II, III, aVF, V5, V6) combined with LVH and T-wave inversions — is pathognomonic for hypertrophic cardiomyopathy (HCM). This pattern occurs in 90–95% of HCM patients and results from the asymmetric hypertrophy and myocyte disarray characteristic of HCM. The clinical context (young athlete, family history of SCD, exertional murmur that increases with Valsalva) further confirms HCM. HCM is the most common inherited cardiac disease (prevalence ~1:500) with autosomal dominant inheritance caused by mutations in sarcomeric protein genes, most commonly MYH7 (beta-myosin heavy chain) and MYBPC3 (myosin-binding protein C). The ACC/AHA 2024 HCM Guidelines emphasize that the combination of deep narrow Q-waves, LVH on ECG, and a dynamic systolic murmur is highly specific for HCM.
Why each distractor is wrong
Acute myocardial infarction with inferolateral wall involvement: While acute MI can produce Q-waves and T-wave inversions in inferolateral leads, these Q-waves are typically broader and accompanied by ST-segment elevation or depression in the acute phase. Acute MI would not produce the LVH voltage criteria or the characteristic dynamic murmur. The clinical presentation (family screening, exertional murmur) is inconsistent with acute MI.
Restrictive cardiomyopathy with amyloid infiltration: Restrictive cardiomyopathy presents with restrictive physiology and often shows low-voltage QRS complexes (especially in cardiac amyloidosis), not LVH voltage criteria. The deep narrow Q-waves in inferolateral distribution are not typical of restrictive disease. The dynamic systolic murmur and Valsalva response are absent in restrictive cardiomyopathy.
Dilated cardiomyopathy with secondary ischemic changes: Dilated cardiomyopathy typically presents with diffuse low-voltage QRS complexes and diffuse T-wave changes, not the characteristic deep narrow Q-waves in a specific inferolateral distribution. The LVH pattern and dynamic murmur are not features of dilated cardiomyopathy.
High-YieldNEET PG
Deep narrow (pseudo-infarction) Q-waves in inferolateral leads + LVH on ECG + dynamic systolic murmur increasing with Valsalva = HCM until proven otherwise; ECG abnormalities present in 90–95% of HCM patients, often before echo findings.
ACC/AHA HCM Guidelines 2024
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