ECG of the Week - 22nd October 2012 - Interpretation

This week's ECG is the second part of our story. 
This ECG is from the same 33 year old male we looked at last week and was taken 7 minutes after last week's ECG

Click to enlarge

Rate:

• 72

Rhythm:

• Regular
• Sinus Rhythm

Axis:

• Normal (~40 deg)

Intervals:

• PR - Normal (~200ms)
• QRS - Normal (80-100ms)
• QT - 320ms (QTc Bazette ~ 350 ms)

Segments:

• Slight Concave ST Elevation V1-3

Additional:

• U Waves V2-4
• Notching of QRS Complexes seen best in V3, III
• Q wave aVL looks >25% of associated R wave (Thanks Jason)
• Compared with last weeks ECG resolution of features of WPW

Interpretation:

• Intermittent Pre-Excitation

There is a great case review of intermittent pre-exciting during sedation by Wakita el al which includes a review of some of the literature. Wakita et al quotes the incidence of intermittent pre-excitation to be between 20 - 60% of all cases of WPW.

In his comments on this week's ECG Jason has mentioned 'Loss of Precordial T-Wave Balance' and 'NTTV1' to find out more about this check out Amal Mattu's video here.


References / Further Reading

Life in the Fast Lane

• Wolff-Parkinson-White here

Articles

• Wakita R, Takahashi M, Ohe C, Kohase H, Umino M. Occurrence of intermittent Wolff-Parkinson-White syndrome during intravenous sedation. J Clin Anesth. 2008 Mar;20(2):146-9. PMID: 18410873

 

Textbook

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