Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy

Mayme Marshall, Aneeq Malik, Maully Shah, Frank A. Fish, Susan P. Etheridge, Peter F. Aziz, Mark W. Russell, Svjetlana Tisma, Andreas Pflaumer, Narayanswami Sreeram, Peter Kubus, Ian H. Law, Michal J. Kantoch, Naomi J. Kertesz, Margaret Strieper, Christopher C. Erickson, Jeremy P. Moore, Stephanie J. Nakano, Harinder R. Singh, Philip ChangMitchell Cohen, Anne Fournier, Maria V. Ilina, Frank Zimmermann, Michaela Horndasch, Walter Li, Anjan S. Batra, Leonardo Liberman, Robert Hamilton, Christopher M. Janson, Shubhayan Sanatani, Ilana Zeltser, George McDaniel, Andrew D. Blaufox, Jason M. Garnreiter, Seshadri Balaji

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Hypertrophic cardiomyopathy (HCM), a common cardiomyopathy in children, is an important cause of morbidity and mortality. Early recognition and appropriate management are important. An electrocardiogram (ECG) is often used as a screening tool in children to detect heart disease. The ECG patterns in children with HCM are not well described.ECGs collected from an international cohort of children, and adolescents (≤ 21 years) with HCM were reviewed. 482 ECGs met inclusion criteria. Age ranged from 1 day to 21 years, median 13 years. Of the 482 ECGs, 57 (12%) were normal. The most common abnormalities noted were left ventricular hypertrophy (LVH) in 108/482 (22%) and biventricular hypertrophy (BVH) in 116/482 (24%) Of the patients with LVH/BVH (n = 224), 135 (60%) also had a strain pattern (LVH in 83, BVH in 52). Isolated strain pattern (in the absence of criteria for hypertrophy) was seen in 43/482 (9%). Isolated pathologic Q waves were seen in 71/482 (15%). Pediatric HCM, 88% have an abnormal ECG. The most common ECG abnormalities were LVH or BVH with or without strain. Strain pattern without hypertrophy and a pathologic Q wave were present in a significant proportion (24%) of patients. Thus, a significant number of children with HCM have ECG abnormalities that are not typical for “hypertrophy”. The presence of the ECG abnormalities described above in a child should prompt further examination with an echocardiogram to rule out HCM.

Original languageEnglish (US)
JournalPediatric cardiology
StateAccepted/In press - 2023


  • Electrocardiogram
  • Hypertrophic cardiomyopathy
  • Left ventricular hypertrophy
  • Pediatric
  • Strain
  • Sudden death

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine


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