Wednesday, 14 February 2018

ECG of the Week - 12th February 2018 - Interpretation

The following ECG is from a 12 yr old male who presented to the Emergency Department following an episode of palpitations and near-syncope. he has no past medical history.




Click to enlarge
Rate:
  • 66 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Normal
Intervals:
  • PR - Short(~100ms)
  • QRS - Prolonged (120ms)
  • QT - 360ms (QTc Bazette 380 ms)
Additional:

  • T wave inversion leads aVR, aVL, V1
  • Biphasic T wave in lead V2
  • Delta wave best seen in leads I,V2-4
  • Notching initial portion of QRS in leads II, III, aVF

Interpretation:

  • Wolff-Parkinson-White (WPW) Syndrome
  • Pre-excitation evidence by PR shortening, QRS prolongation and Delta Waves

What happened ?

Given the history of near syncope with palpitations the patient was admitted under paediatric cardiology for monitoring of likely tachyarrhythmia.

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.