Wednesday, 30 December 2015

ECG of the Week - 28th December 2015 - Interpretation

This ECG is from a 14 yr old female who presented with pleuritic left sided chest pain for 2 days. She is normally fit & well.
Check out the comments from our original post here.



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Rate:

  • 75 bpm
Rhythm:
  • Regular
  • Sinus rhythm 
Axis:
  • Normal 
Intervals:
  • PR - Short (100 ms)
  • QRS - Prolonged (120 ms)
  • QT - 380 ms (QTc Bazette 425 ms)
Segments:
  • ST Elevation leads aVR, V1-3
  • ST Depression leads I, II, III, aVF, V5-6
Additional:
  • Delta Waves leads I, II, III, aVF, V5-6
  • Voltage criteria for LVH
    • S wave V1 + R wave V5 > 35mm
    • NOTE in the setting of pre-excitation this reflects the pre-excitated depolarisation rather than morphological LVH
Interpretation:
  • Wolff-Parkinson-White (WPW)
    • PR Shortening
    • QRS Prolongation
    • Delta Waves
  • Anteroseptal pathway (Arruda Algorithm)
  • ST changes and apparent / 'pseudo' LVH due to pre-excitation
What happened ?

The patient had a normal chest x-ray and a diagnosis of chest wall pain was made. There was no prior history of syncope or palpitations and she was referred for paediatric cardiology follow-up.

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.