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- PR - Short (~200ms)
- QRS - Normal (80ms)
- QT - 320ms (QTc Bazette 365ms)
- Subtle ST depression leads I, V4-6
- Voltage criteria LVH
- S wave V1 + R wave V6 =~38mm
- Short pr
- Could this be Lown-Ganong-Levine ?
- Voltage criteria for LVH
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
The patient was discharge with on-going obstetric follow-up.
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:
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.