ECG of the Week: ECG of the Week - 19th January 2015

Sunday, 25 January 2015

ECG of the Week - 19th January 2015 - Interpretation

This ECG is from a 23 yr old female who presented to the Emergency Department following an episode of palpitations. She is fit & healthy and was asymptomatic when this ECG was performed.
Check out the comments from our original post here.

Click to enlarge

Rate:

~66 bpm

Rhythm:

Regular
Sinus rhythm

Axis:

Normal (~40 deg)

Intervals:

PR - Short (100ms)
QRS - Prolonged (140ms)
QT - 440ms

Segments:

Discordant ST-segments changes

ST Elevation leads aVR, V1-3
ST Depression leads I, II, aVL, aVF, V5-6

Additional:

Delta-waves lateral leads
Dominant S wave lead V1

Type B Pattern

Interpretation:

Wolff-Parkinson-White Syndrome

Short PR segment
QRS Prolongation
Delta waves

Accessory Pathway Location

There are a number of algorithms that can be used to estimate the location of the accessory pathway (AP). Many of these algorithms can be found in smartphone apps, I use EP Mobile which contains the following algorithms:

Arruda Algorithm
Milstein Algorithm
Modified Arruda Algorithm

For this particular ECG are the algorithms give the same AP location which is antero-septal.
You can find an overview of each of these algorithms at ECGpedia's WPW page.

What are you going to tell your patient ?

I've put some links here to various patient information resources for WPW, I have not vetted or reviewed all these links but have chosen those from government / institutional sites.