The following ECG is from a 24 yr old male who presents to the Emergency Department following a sporting injury. An ECG was performed as the patient stated they had a prior cardiac history. He had undergone an EP study and ablation for pre-excitation.
The following ECG is from a 23 yr old female who presents to the Emergency Department with lower limb cellulitis. A 'routine' ECG was performed.
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PR - Short (~120ms)
QRS - Prolonged (130ms)
Best seen leads II, III, aVF, V2-6
Deep Q wave in lead aVL
'Pseudo-infarction' pattern - secondary to pre-excitation rather than actual prior infarction
ST depression and prominent R waves in leads V2-5
RsR' pattern lead V1
Reflecting change secondary to pre-excitation rather than actual RV hypertrophy or 'strain'
Wolff-Parkinson-White Syndrome / Pre-excitation
Type A / Left-sided AP pattern
Accessory pathway is located left lateral / anterolateral using Arruda algorithm
What should you do ? You must inform the patient of the ECG findings and establish if there have been an symptoms of concern including:
Palpitations / Arrhythmia
Family history of Sudden Cardiac Death (SCD)
Presence of known structural cardiac disease
In the absence of these features the patient does not require urgent cardiology input but can be referred as an out-patient for review. Long-term considerations including further investigation such as stress testing (to assess the response to exercise), echo (to assess for presence of structural disease) and EP study. Management options include observational follow-up only, drug therapy or RF ablation. References / Further Reading