Friday, 17 July 2015

ECG of the Week - 13th July 2015 - Interpretation

This ECG is from a 36 year old male who presented to the Emergency Department with 8 hours of right sided chest pain.
Check out the comments from our original post here.




Click to enlarge

Rate:
  • 72
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Short (~100ms)
  • QRS - Pronlonged (110ms)
  • QT - 340ms
Segments:
  • ST Depression lead aVL, V6
  • ST Elevation leads aVR, V1 (<1mm)
Additional:
  • Delta wave best seen leads I, V2, V3
  • Notching initial portion QRS leads II, V4-6
  • Marked prominent T wave lead V3
  • Q waves leads III, aVF
Interpretation:
 
  • Wolff-Parkinson- White
    • Short pr, delta waves & QRS widening
    • Right Lateral Wall AP using Arruda Algorithm
    • Inferior Q waves secondary to AP conduction - "pseudo-infarction"
  • Prominent T wave in lead V3
    • This looked suspicous to me and would have prompted serial ECG's and urgent review of any prior ECGs
 
What happened ?

The patient had known WPW at the time of presentation and had a normal stress echo and EST the year prior following an Emergency Department attendance with chest pain.
Old ECG's were identical to the one shown here and serial ECG's revealed no dynamic changes.
Serial biomarkers were negative and the patient was discharge with out-patient cardiology follow-up

A must read post

I'd encourage all our readers to look at this post from Dr Smith with some great examples of WPW with and without superimposed ischaemia:


References / Further Reading
 
Life in the Fast Lane
 
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.