A 27-year-old woman presents to her primary care provider for a routine physical examination. She denies any heart disease and has never had any cardiac symptoms. However, on physical examination, the clinician detects an irregular heart rhythm, and a 12-lead ECG is obtained.
What does her ECG reveal?
1-Atrial flutter.
2-Atrial fibrillation.
3-Normal sinus rhythm with premature ventricular complexes.
4-Normal sinus rhythm with aberrantly conducted premature atrial complexes (PACs).
5-Normal sinus rhythm with PACs and Wolff-Parkinson-White (WPW).
Dear Mustafa Mahmood Eid
Do you concur with my diagnosis seconded by others?
Sinus rhythm with atrial bigeminy. WPW Right Posterolateral pathway(because QRS is negative in V1, transition is after V4 and III avf are negative)
You are totally right dear (@muhammad Yousuf) in addition to our other colleagues
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It is 5- Normal sinus rhythm with PACs and Wolff-Parkinson-White (WPW).. Thank you all
The rhythm is irregular and there is a pattern of group beating (ie, two QRS complexes followed by a pause). The average rate is 66 beats/min. The first of the QRS complexes has a P (+) wave with a stable PR interval (0.12 sec). The P wave is positive in leads I, II, aVF, and V4-V6. Hence, this is a normal sinus rhythm. The P wave before the second QRS complex (*) has a different morphology. This is a PAC. Because every other QRS complex is a PAC, this is atrial bigeminy. The PR associated with the PAC is shorter (0.10 sec). All of the QRS complexes have the same morphology, but the first of the two (ie, the sinus complex) is slightly narrower (0.12 sec) than the second (0.14 sec)—the PAC. Both QRS complexes have a slurred upstroke (↑,^), making the base of the QRS complex wider than the peak. The slurred upstroke is due to a delta wave; along with the short PR interval, this is a WPW pattern. The PAC has a slightly shorter PR interval and is more preexcited (the delta wave is more prominent and the PR interval is shorter) as a result of slowing of atrioventricular (AV) nodal conduction. This results in more of the ventricular myocardium being activated via the accessory pathway. The PAC arrives at the AV node earlier, and with decremental conduction it is conducted through the node more slowly than the sinus complex.
On looking ECG , it seems to be normal sinus rhythm with premature ventricular Complex
On carefull reading of ECG , there is presence of positive deflection of P wave in I,II,aVF and V4-6 indicating normal sinus rhythm. R-R interval are variable and short PR interval with wide base of QRS complex than P peak indicating slurred upstroke is due to delta wave. There is also Premature atrial contraction giving the clue for WPW syndrome
Sinus rhythm and unifocal (most likely) ectopic atrial depolarisation, bigeminus pattern with accessory pathway right postero septal. Would like to see threadmill exercise to evaluate anterograde conduct competency in regard to heart rate and overall chronotropic competence before EP
It shows sinus rhythm, supraventricular bigeminism and WPW pattern.
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