Available online 28 March 2024

Electrocardiogram of a patient affected by hypertrophic cardiomyopathy showed normal PR and QRS intervals and signs of left ventricular hypertrophy. In leads I,V5 and V6 the initial q waves were absent. A subsequent electrocardiogram revealed the appearance of prominent anterior QRS forces expressed by a change from rS to R pattern in leads V2 and V3 with a tall R wave in V2. PR and QRS intervals and QRS axis remained substantially unchanged. Other electrocardiograms showed day-to-day variations of the anterior displacement of QRS complex. The different degrees of anterior displacement appear to be an expression of an underlying left septal fascicular block, but a diagnosis cannot be made with certainty.

A 68-old-womam was admitted to our hospital because of urinary infection. She was affected by congenital encephalopathy with dementia and some slight palsies. The etiology of this encephalopathy has never been thoroughly investigated. She was also affected by non-obstructive hypertrophic cardiomyopathy. Echocardiogram showed a left ventricular hypertrophy pattern (thickness at septum and free wall level 15 and 14 mm, respectively, left ventricular mass 115 g/m2 and left ventricular systolic

In patients with hypertrophic cardiomyopathy tall R waves can be observed in the right precordial leads because of severe septal hypertrophy [1]. However, in the present case this pattern is intermittent with different degrees of anterior displacement of QRS complex and, therefore, it should be attributed to an intraventricular conduction disturbance. Histological, physiological and pathophysiological studies have shown that PAFs can be an expression of an underlying block of the septal

This research did not receive any specific grant from funding agencies in the public, commercial and not-for-profit sectors.

The author declares that the manuscript is original, it has not been published previously and it is not under consideration for publication elsewhere.

Paolo Alboni: Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing.

None declared

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