Table 5.

Left Ventricular Scars in the Inferior Region With Specific Disease Characteristics

LV Scar	Distribution	Phenotype	Red Flags		Etiologies	Further Investigation
Inferior region	Mid-wall/transmural	HCM	CLINICAL:	•Family history of HCM or SCD	Sarcomeric HCM	Genetic testing
			ECG:	•“Pseudo STEMI” pattern
			ECHO:	•Mitral valve abnormalities: elongated anterior leaflet/SAM
				•Apical or asymmetric LVH
	Mid-wall	NDLVC/DCM	CLINICAL:	•Young female •Bi-leaflet involvement	Arrhythmic mitral valve prolapse	Rhythm monitoring
			ECG:	•Inverted/biphasic T waves in the inferior leads
				•PVC morphologies compatible with papillary muscle or mitral annular origins
			ECHO:	•Presence of Pickelhaube sign •MAD •Systolic curling
	Subepicardial/transmural	DCM/HCM	CLINICAL:	•Pulmonary disease •Unexplained brady or tachyarrhythmia	Sarcoidosis	Thoracic FDG-PET imaging
			ECG:	•PR prolongation •Advanced AV blocks •RBBB/LBBB
			ECHO:	•Basal septum thinning •Regional LV thickening
				•RV dysfunction in absence of PH
				•Regional wall motion abnormalities (without coronary distribution)

AV = atrioventricular; DCM = dilated cardiomyopathy; FDG-PET = fluorodeoxyglucose positron emission tomography; HCM = hypertrophic cardiomyopathy; LBBB = left bundle branch block; LVH = left ventricular hypertrophy; MAD = mitral annular disjunction; NDLVC = nondilated left ventricular cardiomyopathy; PH = pulmonary hypertension; PVC = premature ventricular complex; RBBB = right bundle branch block; RV = right ventricular; SAM = systolic anterior motion; SCD = sudden cardiac death; STEMI = ST fluorodeoxyglucose positron emission tomography elevation myocardial infarction.