ECG of the Week - 28th December 2015 - Interpretation

This ECG is from a 14 yr old female who presented with pleuritic left sided chest pain for 2 days. She is normally fit & well.
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Rate:

• 75 bpm

Rhythm:

• Regular
• Sinus rhythm 

Axis:

• Normal 

Intervals:

• PR - Short (100 ms)
• QRS - Prolonged (120 ms)
• QT - 380 ms (QTc Bazette 425 ms)

Segments:

• ST Elevation leads aVR, V1-3
• ST Depression leads I, II, III, aVF, V5-6

Additional:

• Delta Waves leads I, II, III, aVF, V5-6
• Voltage criteria for LVH
• S wave V1 + R wave V5 > 35mm
• NOTE in the setting of pre-excitation this reflects the pre-excitated depolarisation rather than morphological LVH

Interpretation:

• Wolff-Parkinson-White (WPW)
• PR Shortening
• QRS Prolongation
• Delta Waves
• Anteroseptal pathway (Arruda Algorithm)
• ST changes and apparent / 'pseudo' LVH due to pre-excitation

What happened ?

The patient had a normal chest x-ray and a diagnosis of chest wall pain was made. There was no prior history of syncope or palpitations and she was referred for paediatric cardiology follow-up.

References / Further Reading

Life in the Fast Lane

• Left Ventricular Hypertrophy
• Pre-Excitation / WPW

 Textbook

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