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

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

  • 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
  • Wollff-Parkinson-White here

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


  1. It is not biphasic T in V4.Is it?In my understanding positive T wave followed by a negative T wave is biphasic T as you see in Wellen`s.In this ECG,there is downsloping ST segment followed by an upright T.

  2. Hi Anon,

    Thanks for the comments. Happy to hear people are looking at the site and hopefully enjoying it.

    In terms of biphasic T waves my understanding is they can either be positive to negative or negative to positive.

    I called it biphasic due to the negative notching at the end of the ST segement similar to that seen in V3's inverted T wave with a subsequent positive deflection. I though V4 represented a T wave transistion point if you will between negative T waves to positive T waves.

    I'm not sure there really is a right answer though.