Wednesday, 14 March 2012

ECG of the Week - 12th March 2012 - Interpretation

This weeks ECG for interpretation is from an 18 yr old female.
She presented following a syncopal episode.





Click to enlarge

Rate:
  • 70
Rhythm:
  • Sinus Rhythm
  • Sinus Arrhythmia 
 Axis:
  • Normal (~70 deg)
Intervals:
  • PR - Short (~80-100ms)
  • QRS - Prolonged (~120-160ms)
  • QT - 400-440ms (QTc Bazette ~ 445-490 ms)
Segments:
  • ST Depression V1-5
Additional:
  • T Inversion V1-3, aVR
  • Biphasic T V4
  • Slurring upstroke QRS
  • Dominant R wave V1 (R/S Ratio >1)

Interpretation:
  • Short pr
  • Slurring QRS Upstroke - Delta wave

  • Consistent with Wolff-Parkinson-White

  • Note changes similar to Right Ventricular Hypertrophy with strain - Dominant R wave V1, R/S ratio > 1 in V1, ST depression & T inversion anterior leads
  • These changes are seen in WPW due to pre-excitation and are not due to actual hypertrophy

References / Further Reading

Life in the Fast Lane

  •  Wolff-Parkinson-White here
  • Right Ventricular Hypertrophy here
eMedicine
  • Wollff-Parkinson-White here

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.