This ECG is from a 33 year old male, don't know why he presented.
|Click to enlarge|
- Sinus Rhythm
- Normal (65 deg)
- PR - Short (~100-110 ms)
- QRS - Prolonged (120ms)
- QT - 360ms (QTc Bazette ~ 410 ms)
- Discordant ST depression V2-5, II, III, aVF
- Minor discordant ST elevation aVR, aVL
- Delta wave - slurred upstroke of QRS complexes best seen V2-6, II, III, aVF
- Negative QRS deflection aVL - pseudo-infarction pattern
- T Inversion V1-5, II, III, aVF
- Prominent R waves - R/S > 1 in Lead V1 - likely pseudo-hypertrophy
- Wolff-Parkinson-White (Type A Pattern)
I've link below to the PubMed reference for a nice article by Khan et al. which goes through two cases and looks at the patterns of pseudo-hypertrophy and pseudo-infarction that can accompany WPW.
Christopher makes a good point in his comments that whilst the ST changes are most likely due to WPW we should consider the possiblility of ischaemia / infarction. Remember serial ECGs and clinical correlation.
References / Further Reading
Life in the Fast Lane
- Wolff-Parkinson-White here
- Khan IA, Shaw IS. Pseudo ventricular hypertrophy and pseudo myocardial infarction in Wolff-Parkinson-White syndrome. Am J Emerg Med. 2000 Nov;18(7):807-9. PMID: 11103733
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.