ECG Challenge Response ECG Response: February 10, 2015 ECG Challenge: A 21-year-old male college student without any known cardiac problems presents to his college health service with concerns of intermittent palpitations that occur sporadically. They generally last only for a few minutes, although he did have 1 more prolonged episode 1 week before. This episode also terminated spontaneously. The results of his physical examination are unremarkable. An ECG is obtained.
There is a regular rhythm at a rate of 64 bpm. There are P waves seen before each QRS complex (+), and the P wave is positive in leads I, II, aVF, and V4 through V6. Hence, there is a normal sinus rhythm. The QRS complexes have 2 different morphologies. There are 2 narrow QRS complexes (*) with a normal duration (0.08 s). They appear to have a normal morphology, but because they are only seen in leads II and V1 through V3, this is not certain. The QT/QTc intervals of these complexes are normal (380/390 ms). The PR intervals associated with these 2 complexes are the same and are normal (0.20 s). The remaining QRS complexes are wide (0.16 s) with a morphology suggestive of a left bundle-branch block with a deep QS complex in lead V1 (←) and a broad R wave in leads I and V5 to V6 (→). The QRs complex widening is a result of a very slow (slurred)
Correspondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] (Circulation. 2015;131:591-592. DOI: 10.1161/CIRCULATIONAHA.114.015198.) © 2015 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.015198
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592 Circulation February 10, 2015 upstroke of the QRS complex (^). In addition, the PR interval associated with these complexes is constant but is different from the narrow complexes (despite the same sinus P wave preceding them). The PR interval is short (0.10 s). The short PR interval and widened QRS complex with a slurred upstroke is characteristic of Wolff-Parkinson-White pattern. The slurred upstroke is called a delta wave. In this case, the Wolff-Parkinson-White pattern is intermittent, alternating with conduction that is normal. Please go to the journal’s blog, OpenHeart, for more ECG Challenges: http://goo.gl/tQPNFp. Challenges are posted on Tuesdays and Responses on Wednesdays.
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ECG Response: February 10, 2015 Circulation. 2015;131:591-592 doi: 10.1161/CIRCULATIONAHA.114.015198 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/131/6/591
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There is a regular rhythm at a rate of 64 bpm. There are P waves seen before each QRS complex (+), and the P wave is positive in leads I, II, aVF, and V4 through V6. Hence, there is a normal sinus rhythm. The QRS complexes have 2 different morphologies. There are 2 narrow QRS complexes (*) with a normal duration (0.08 s). They appear to have a normal morphology, but because they are only seen in leads II and V1 through V3, this is not certain. The QT/QTc intervals of these complexes are normal (380/390 ms). The PR intervals associated with these 2 complexes are the same and are normal (0.20 s). The remaining QRS complexes are wide (0.16 s) with a morphology suggestive of a left bundle-branch block with a deep QS complex in lead V1 (←) and a broad R wave in leads I and V5 to V6 (→). The QRs complex widening is a result of a very slow (slurred)
Correspondence to Philip J. Podrid, MD, West Roxbury VA Hospital, Section of Cardiology, 1400 VFW Pkwy, West Roxbury, MA 02132. E-mail [email protected] (Circulation. 2015;131:591-592. DOI: 10.1161/CIRCULATIONAHA.114.015198.) © 2015 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.015198
Downloaded from http://circ.ahajournals.org/ at SUNY Health Science Center on April 14, 2015 591
592 Circulation February 10, 2015 upstroke of the QRS complex (^). In addition, the PR interval associated with these complexes is constant but is different from the narrow complexes (despite the same sinus P wave preceding them). The PR interval is short (0.10 s). The short PR interval and widened QRS complex with a slurred upstroke is characteristic of Wolff-Parkinson-White pattern. The slurred upstroke is called a delta wave. In this case, the Wolff-Parkinson-White pattern is intermittent, alternating with conduction that is normal. Please go to the journal’s blog, OpenHeart, for more ECG Challenges: http://goo.gl/tQPNFp. Challenges are posted on Tuesdays and Responses on Wednesdays.
Downloaded from http://circ.ahajournals.org/ at SUNY Health Science Center on April 14, 2015
ECG Response: February 10, 2015 Circulation. 2015;131:591-592 doi: 10.1161/CIRCULATIONAHA.114.015198 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2015 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539
The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/131/6/591
Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/
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