The following ECG is from a 28 yr old female who is 20 weeks pregnant. She presented complaining of dysponea and chest pain.
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- PR - Short (80ms)
- QRS - Prolonged (120ms)
- QT - 400ms (QTc Bazette 380-400 ms)
- Delta waves leads I, aVL
- Deep Q wave leads III, aVF
- T wave inversion leads aVL, V1, V2, aVR
- Voltage criteria LVH
- Pre-excitation (WPW)
- Deep Q waves in inferior leads mimic old inferior MI referred to as pseudo-infarction pattern this is due to pre-excitation and does not reflect prior ischaemia.
- AP location is postero-septal tricuspid annulus using Arruda algorithm
What happened ?The patient had known WPW, it would spoil the fun if I told you that in advance. She was investigated from a possible PE which was negative and discharged.
References / Further Reading
Life in the Fast LaneTextbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.