ECG of the Week - 15th October 2012 - Interpretation

 

This week's ECG is the first part of a two part story. 
This ECG is from a 33 year old male, don't know why he presented.

 

  

Click to enlarge

 

Rate:

• 78

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal (65 deg)

Intervals:

• PR - Short (~100-110 ms)
• QRS - Prolonged (120ms)
• QT - 360ms (QTc Bazette ~ 410 ms)

Segments:

• Discordant ST depression V2-5, II, III, aVF
• Minor discordant ST elevation aVR, aVL

Additional:

• Delta wave - slurred upstroke of QRS complexes best seen V2-6, II, III, aVF
• Negative QRS deflection aVL - pseudo-infarction pattern
• T Inversion V1-5, II, III, aVF
• Prominent R waves - R/S > 1 in Lead V1 - likely pseudo-hypertrophy

Interpretation:

• Wolff-Parkinson-White (Type A Pattern) 

I've link below to the PubMed reference for a nice article by Khan et al. which goes through two cases and looks at the patterns of pseudo-hypertrophy and pseudo-infarction that can accompany WPW.

Christopher makes a good point in his comments that whilst the ST changes are most likely due to WPW we should consider the possiblility of ischaemia / infarction. Remember serial ECGs and clinical correlation.

References / Further Reading

 

Life in the Fast Lane

• Wolff-Parkinson-White here

Articles

• Khan IA, Shaw IS. Pseudo ventricular hypertrophy and pseudo myocardial infarction in Wolff-Parkinson-White syndrome. Am J Emerg Med. 2000 Nov;18(7):807-9. PMID: 11103733

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.