Beste echo-fanaten, Tijdens de 7e editie van EMRecap op 8 november as zal ook dit jaar weer de spoedechografie-competitie Sonowars georganiseerd worden: AUS DER REIHE… SONOWARS !!! De winnaars van vorig jaar waren “The Wild Wild East”. Zij gaan natuurlijk proberen hun te titel verdedigen. Met wie zullen zij dit jaar de probes kruisen? Er […]
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.
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Things to think about
- What are the key ECG features ?
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- 66 bpm
- Sinus rhythm
- PR – Short (~120ms)
- QRS – Prolonged (130ms)
- Delta waves
- 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
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.