ECG of the Week - 25th August 2014 - Interpretation

This ECG is from a 45 yr old male presenting to the Emergency Department following an episode of chest pain. He was pain  free when this ECG was recorded.

Check out the comments from our original post here.

Click to enlarge

Rate:

• 60

Rhythm:

• Sinus arrhythmia

Axis:

• Normal

Intervals:

• PR - Short (100ms)
• QRS - Prolonged (140ms)
• QT - 400ms (QTc Bazette 400 ms)

Segments:

• ST Elevation leads aVR, V1-4
• ST Depression leads I, II, III, aVF, V5-6

Additional:

• Voltage criteria for LVH
• Delta waves best seen infero-laterally

Interpretation:

• Wolff-Parkinson-White Syndrome
• ST segment changes proportional and discordant to QRS direction
• Anteroseptal pathway (Arruda Algorithm)

What happened ?

The patient had known WPW and serial ECG's and biomarkers were negative and he was referred for an out-patient provocation test.

References / Further Reading

Life in the Fast Lane

• Pre-excitation syndromes 

Textbook

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