Wednesday, 24 October 2012

ECG of the Week - 22nd October 2012 - Interpretation



This week's ECG is the second part of our story. 
This ECG is from the same 33 year old male we looked at last week and was taken 7 minutes after last week's ECG




Click to enlarge

Rate:
  • 72
Rhythm:
  • Regular
  • Sinus Rhythm

Axis:
  • Normal (~40 deg)
Intervals:
  • PR - Normal (~200ms)
  • QRS - Normal (80-100ms)
  • QT - 320ms (QTc Bazette ~ 350 ms)
Segments:

  • Slight Concave ST Elevation V1-3

Additional:

  • U Waves V2-4
  • Notching of QRS Complexes seen best in V3, III
  • Q wave aVL looks >25% of associated R wave (Thanks Jason)
  • Compared with last weeks ECG resolution of features of WPW

Interpretation:
  • Intermittent Pre-Excitation
There is a great case review of intermittent pre-exciting during sedation by Wakita el al which includes a review of some of the literature. Wakita et al quotes the incidence of intermittent pre-excitation to be between 20 - 60% of all cases of WPW.

In his comments on this week's ECG Jason has mentioned 'Loss of Precordial T-Wave Balance' and 'NTTV1' to find out more about this check out Amal Mattu's video here.


References / Further Reading

Life in the Fast Lane

  • Wolff-Parkinson-White here
Articles
  • Wakita R, Takahashi M, Ohe C, Kohase H, Umino M. Occurrence of intermittent Wolff-Parkinson-White syndrome during intravenous sedation. J Clin Anesth. 2008 Mar;20(2):146-9. PMID: 18410873
 
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.