ECG Diagnosis:

Wolff-Parkinson White syndrome type A in sinus rhythm

This is based on clear and characteristic findings in Lead V2, that is also replicated in the rhythm strip in the lower part of the image:

1. Short PR interval (< 1.2 mm)

2. A delta wave

3. A wide QRS produced by the delta wave

A predominant R wave in in all the chest leads is diagnostic of Type A WPW syndrome. The definitive diagnosis is made by electrophysiological study before treatment by radioablation of the the accessary bundle Kent.

There is high risk of having paroxysmal atrial arrhythmias (mainly supraventricular tachycardia, rarely atrial fibrillation) with a high ventricular response.

5

Based on classic ECG findings

I agree that the ECG diagnosis is Wolf Parkinson White. This explains the palpitations. However Hickum's dictat suggests that the patient can have as many diagnoses as they please. So, a pantheon of alternative causes of post-prandial epigastric pain and nausea may co-exist.

You are right all .. it is Wolff-Parkinson White syndrome .. thank you all

I appreciate your participation