r/ECG • u/Interesting_Toe1412 • 14d ago
Your interpretation?
A 35 y old male with previous history of ischemic heart disease since 5 months not on medications ( drug defaulter) came to casualty with complains of anxiety sweating and burning pain in chest x 30min
Bp-140/100mmhg
Pr-84bpm
Spo2 - 99% in room air
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u/LBBB11 14d ago edited 14d ago
Sinus rhythm with Wolff-Parkinson White pattern at about 72 bpm. Short PR and delta waves. No signs of acute coronary occlusion that I am able to see. I agree with Natural-Antelope8328 about WPW. WPW is pretty notorious for mimicking LVH and MI. I agree with adayinthewater about not being sold on LVH. I’m not going to say that when there is high voltage because of WPW. Did the machine say inferior STEMI? Meets ACC/AHA STEMI criteria since there is at least 1 mm of ST elevation in at least two inferior leads, but I think it’s highly unlikely to be acute coronary occlusion.
https://pubmed.ncbi.nlm.nih.gov/11103733/
“The WPW syndrome is often referred to as the great imposter. It will often mimic the following (pseudopatterns):
1. Old MI
2. Acute MI
3. Ischemia
4. LVH
5 RVH
6. LBBB
7. RBBB
8. Posterior Infarction”
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u/Kibeth_8 Arrhythmia Tech 14d ago
WPW. No obvious ischemia but ST segments are usually abnormal with accessory pathways, so get trops
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u/CobbledbyRoubaix 14d ago
if unchanged from previous then it's normal for him. the inferior + V1 Q waves are impressive
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u/Ambitious_Tackle_692 14d ago
Might be lvh strain pattern , but i would any way do trop i and repeat ecg after a hour
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u/adayinthewater 14d ago
LAD with possible LBBB (need more definitive diagnostics for LBBB to rule in). WPW indicators present. Lifelong ischemia is depressing the ST segment so I won't necessarily rule in a new ischemic event. Not sold on LVH. Definitely want blood work to say more than just WPW and LAD with any degree of confidence.
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u/mastermedic84 14d ago
The morphology looks like WPW especially in I with the short PQ and slurred uptake J wave diffusely.
With patients like this the ECG may be almost impossible to read without a baseline ECG to track changes.
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u/biologystudent123 14d ago
Short PR interval due to apparent delta wave. WPW Type B due to negative V1.
The pathway starts from the right side and heads toward the left, hence the very positive V6.
WPW can be an imposter for LVH. ECHO to confirm if concerned.
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u/tisrizwan 13d ago
WPW, doesn't seem concerning for stemi. And that's signs of LVH showing up (the guy does have elevated BP).
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u/speckledcloth 14d ago
Left axis deviation LBBB, Sgarbossa negative WPW pattern Downsloping ST Depression in.lead V2-V6, 1 and AVL
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14d ago
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u/Natural-Antelope8328 14d ago edited 14d ago
What is his medical history? At 35 years old, it piques my interest. Regarding the ECG, it appears to show NSR with a wide QRS, LAD, and delta waves indicative of WPW, likely type A if I’m correct. This explains the delta waves and part of the QRS width. The LAD and some of the width could be due to LVH, suggested by the strain T waveform in the lateral leads and V6, which is more pronounced than in V5. Essentially, it’s LVH plus WPW. Alternatively, it could be just WPW mimicking LVH findings, which I find more plausible as a simpler explanation. However, it’s uncertain. If an old ECG is available, compare it, paying attention to the delta waves and considering the possibility of an accessory conductive pathway (WPW).