Wednesday, 17 October 2012

ECG of the Week - 15th October 2012 - Interpretation

 
This week's ECG is the first part of a two part story. 
This ECG is from a 33 year old male, don't know why he presented.

 




  
Click to enlarge
 



Rate:

  • 78
Rhythm:
  • Regular
  • Sinus Rhythm
Axis:
  • Normal (65 deg)
Intervals:
  • PR - Short (~100-110 ms)
  • QRS - Prolonged (120ms)
  • QT - 360ms (QTc Bazette ~ 410 ms)
Segments:
  • Discordant ST depression V2-5, II, III, aVF
  • Minor discordant ST elevation aVR, aVL
Additional:
  • 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
Interpretation:
  • 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
Articles

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