Letters to the Editor: The importance of Himalayan P-wave in differentiation of cardiomyopathies

Dear Editor, A 22-year-old female who had been previously diagnosed as hypertrophic cardiomyopathy presented with increased exertional dyspnea (NYHA Class III), orthopnea and bilateral pretibial edema for last 6 months. Family history included sudden cardiac death in her brother without known etiology. Physical examination revealed jugular venous distension, S3(+), S4(+), hepatomegaly and bilateral rales at basal segments of the lung. Complete blood count and peripheral smear demonstrated no eosinophilia (0.1x103/μL; Normal: 0.1-0.5 x103/μL). Electrocardiogram showed unexpectedly tall “P” waves (9 mm in lead V2) and right axis deviation (Fig. 1A). Chest X-ray showed evidence of biatrial enlargement (Fig. 1B).