ECG of the Week: ECG of the Week - 27th July 2015

Wednesday, 29 July 2015

ECG of the Week - 27th July 2015 - Interpretation

This ECG is from a 28 year old female who presented complaining of intermittent pre-syncope and palpitations. She is normally fit & well and is 34 weeks pregnant.
Check out the comments from our original post here.

Click to enlarge

Rate:

Rhythm:

Regular

Axis:

Normal

Intervals:

PR - Short (~200ms)
QRS - Normal (80ms)
QT - 320ms (QTc Bazette 365ms)

Segments:

Subtle ST depression leads I, V4-6

Additional:

Voltage criteria LVH

S wave V1 + R wave V6 =~38mm

Interpretation:

Short pr

Could this be Lown-Ganong-Levine ?

Voltage criteria for LVH

What happened ?

The patient was admitted for investigation under joint care of cardiologists and obstetricians.
Investigation for PE was normal. Echo showed:

Normal left ventricular size with normal wall thickness and normal systolic function.
Possible mild dilatation of the right ventricle

May be physiological due to stage of pregnancy.

Normal right ventricular systolic function.
Normal atrial size
No significant valvular abnormality

In-patient telemetry revealed no arrhythmia despite the patient complaining of palpitations.
The patient was discharge with on-going obstetric follow-up.

Lown-Ganong-Levine (LGL)

LGL is often grouped with WPW as part of the pre-excitation syndromes the major ECG difference is that LGL has only pr shortening without the QRS changes associated with WPW. The advent of EP studies has resulted in a greater understanding of cardiac conduction and it's role in arrhythmogenesis with the existence of LGL as a clinical entity disputed. It is likely the short pr reflects an extreme of the normal variation and may not play any role in arrhythmogenesis.
This eMedicine article has a great review of LGL an the current evidence around it's existence as a clinical entity: