Wednesday, 24 August 2016

ECG of the Week - 22nd August 2016 - Interpretation

This ECG is from a 20 yr old female who presented following an episode of palpitations with associated chest pain and dysponea.



Click to enlarge

Rate:
  • 60
Rhythm:
  • Sinus arrhythmia
Axis:
  • Normal
Intervals:
  • PR - Short (~100ms)
  • QRS - Prolonged (120-130ms)
  • QT - 440ms (QTc Bazette 440 ms)
Segments:

  • ST elevation leads III, aVF <1mm with flat morphology

Additional:

  • Delta waves leads I, V1-4
  • Pseudo right ventricular hypertrophy secondary to pre-excitation rather than actual chamber enlargement with the following ECG features:
    • Dominant R wave leads V1-6
    • R/S ratio >1 in lead V1
    • T wave inversion leads aVL, V1-3

Interpretation:

  • Wolff-Parkinson-White Syndrome
    • Left posterior / left posterolateral accessory pathway using Arruda algorithm

What happened ?

The patient had known pre-excitation and had been non-compliant with beta-blocker and sodium-channel blocker therapy. The patient was admitted for telemetry and re-instigation of anti-arrhythmic agents prior to ablation consideration / planning.

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.