P119 WHEN THE ELECTROCARDIOGRAM CHANGES YOUR DIAGNOSIS

Abstract Sarcomeric hypertrophic cardiomyopathy is among the most common genetic cardiovascular diseases.Clinical,electrocardiographic and echocardiographic evaluation plays a crucial role in diagnosis initial framing of phenotype. A 51–year–old Caucasian man with multiple myeloma,previous autologous transplant,undergoing chemotherapy for disease recurrence,without risk factors or family history MCV MCI came to our outpatient clinic follow–up visit.At another center,cardiac amyloidosis was diagnosed due echocardiogram finding concentric left ventricular hypertrophy. Patient asymptomatic angor,NYHAI dyspnea,heart palpitation,syncope,presented rhythmic cardiac action,2/6 systolic murmur at centrum tip,no central peripheral stasis.On ecg sinus bradycardia fc57 bpm,PR202 msec,high QRS V4–V6 voltages negative T waves infero–lateral site,suggestive On echocardiogram:concentric hypertrophy posterolateral papillary hypertrophy,preserved contractile function,FE 62%,grade I diastolic dysfunction,no signs elevated filling pressures,left atrium right ventricle normal range;tripartite aortic valve absence gradients,prolapse LAM(A1–A2)with mild grade insufficiency,mild tricuspid insufficiency. At MRI:non–dilated hypertrophy,maximum thickness 16mm basal SIV level,apical inferior wall,15mm anterior wall,anterolateral media,apex obliteration 14mm,FE 64%.Right atria normal.T2–STIR sequences tenuous hyperintensity media wall,inferior apical wall lateral,increased T2 mapping relation myocardial edema. Subendocardial LGE middle infero–lateral,apical lateral postero–medial wall,slight increase native T1 mapping,ECV 27%,picture sarcomeric heart disease.Holter showed no arrhythmias;at HCM score low risk,no indication ICD implantation. The patient undergoing screening test HCM.The presence may mimic different forms cardiomyopathy,leading misdiagnosis delayed diagnosis.Differential diagnosis,ecg specific use imaging tests are paramount importance.