EKG of the Week

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The EKG was done on a healthy, 23 year old returning soldier with no complaints.

+ EKG Interpretation

Dr. Ohlbaum's Explanation

First of all, this is my favorite EKG from last month!

There are clear P waves and they are regular. But what you notice at first glance is that the QRS's are NOT all the same. The tracing starts in the middle of a QRS so let's start numbering AFTER that: the first, 5th 8th and 9th complexes are different than the others.

So, let's look more carefully. In those (1st full complex, 5, 8, and 9) there is a normal PR and a normal looking QRS. But look at the others. At the end of the other P waves, as soon as the p is over there is the start of "something". In V2 thru V6 it starts going up, as it does in I and II, but in Ill and a VF it goes down. It is a slowly increasing, kind of triangular thing.

That is a DELTA wave.

Sso this person has an accessory pathway -type B WPW because the QRS is negative in Vl and there are upright delta waves in rest of precordial leads. The "Q's" in Ill and AVF are a "pseudo infarction" pattern that goes along with this. Some of the complexes are conducted through the normal AV node and are normal looking, others go through the accessory pathway and have a delta wave and a "funny looking" QRS.

So the answer: Sinus rhythm, with intermittant Type B WPW pattern. Cool?

Further Reading:

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