Wednesday, 20 July 2016

ECG of the Week - 18th July 2016 - Interpretation

The following ECG is from a 28 yr old female who is 20 weeks pregnant. She presented complaining of dysponea and chest pain.


Click to enlarge

Rate:
  • 72 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal (-33 deg)
Intervals:
  • PR - Short (80ms)
  • QRS - Prolonged (120ms)
  • QT - 400ms (QTc Bazette 380-400 ms)
Segments:
  • Nil significant changes
Additional:
  • Delta waves leads I, aVL
  • Deep Q wave leads III, aVF
  • T wave inversion leads aVL, V1, V2, aVR
  • Voltage criteria LVH
    • R wave aVL >11mm
Interpretation:
  • Pre-excitation (WPW)
    • Deep Q waves in inferior leads mimic old inferior MI referred to as pseudo-infarction pattern this is due to pre-excitation and does not reflect prior ischaemia.
    • AP location is postero-septal tricuspid annulus using Arruda algorithm
What happened ?

The patient had known WPW, it would spoil the fun if I told you that in advance. She was investigated from a possible PE which was negative and discharged.

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.