ECG PRESENTATION

DR ABOORVA
JUNIOR RESIDENT-1
PROF DR GEETHA M.D UNIT
DEPT OF GENERAL MEDICINE
• A 25 YEARS MALE WITH NO COMORBIDS CAME TO OP WITH
COMPLAINTS OF GIDDINESS ON AND OFF FOR PAST 1 WEEK
• O/E :CONSCIOUS , ORIENTED, NOT DYSPNEIC
• CVS:S1S2+
• RS:BAE+
• P/A:SOFT
• CNS:NFND
• BP:120/80 MMHG
• PR:64/MIN
• SPO2:98% IN RA
• 12 LEAD ECG
• NORMAL STANDARDISATION
• LEFT AXIS DEVIATION
• NORMAL SINUS RHYTHM
• RATE 63/MIN
• P WAVES – PRESENT
• PR INTERVAL – 101MS
• QRS – 142 MS
• QT INTERVAL – 407MS, QTC – 417MS
• DELTA WAVE
• DIRECTION OF T WAVES OPPOSITE TO THAT OF DELTA WAVE
WOLFF PARKINSON WHITE SYNDROME
• IN WPW SYNDROME, A BYPASS TRACT IS PRESENT,
WHICH CONNECTS THE ATRIUM DIRECTLY TO THE
VENTRICLES . THE ACCESSORY PATHWAY CAN
CAUSE PREMATURE ACTIVATION OF THE
VENTRICLES. IT CAN ALSO SERVE AS A PATHWAY
FOR REENTRY WHICH MAY RESULT IN CLINICAL
SYMPTOMS OF PAROXYSMAL TACHYCARDIA
 ACCESSORY PATHWAYS
CONCEALED ACCESSORY PATHWAY
• ONLY CONDUCTS IN RETROGRADE DIRECTION
• DOES NOT CHANGE THE APPEARANCE OF ECG IN SINUS
RHYTHM
MANIFEST ACCESSORY PATHWAY
• CONDUCTS IN ANTEROGRADE DIRECTION
• DISTORTS THE QRS COMPLEX
• SHORT PR INTERVAL- DUE TO PREMATURE VENTRICULAR
ACTIVATION
 ECG FINDINGS

SHORT PR INTERVAL
• BECAUSE BYPASS TRACT CONDUCTS MORE RAPIDLY
THAN AV NODE CAUSING VENTRICLES TO BE EXCITED
PREMATURELY
DELTA WAVE
• INITIAL PORTION OF QRS COMPLEX WITH A SLOW
UPSTROKE. BECAUSE CONDUCTION OF IMPULSE IS BY
DIRECT MUSCLE SPREAD, WHICH IS SLOW AND
INEFFICIENT, THIS CAUSES INITIAL PORTION OF QRS TO
BE INSCRIBED SLUGGISHLY
ST AND T WAVE ABNORMALITIES
• THE ST AND T WAVE CHANGES ARE SECONDARY
TO ABNORMAL ACTIVATION OF VENTRICLES.
THE DIRECTION OF ST SEGMENT AND T WAVE IS
OPPOSITE THAT OF THE DELTA WAVE.
 COMPLICATIONS

• ATRIAL FLUTTER
• ATRIAL FIBRILLATION
• SUPRAVENTRICULAR TACHYCARDIA
• VENTRICULAR TACHYCARDIA
• VENTRICULAR FIBRILLATIONSUDDEN DEATH
 TREATMENT

• ASYMPTOMATIC PATIENTS – REASSURANCE.

ELECTROPHYSIOLOGIC TESTING IS NOT
RECOMMENDED
• SYMPTOMATIC PATIENTS – ABLATION
THERAPY
THANK YOU