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ECG OF THE WEEK
Prof.Dr.MAHESH KUMAR’s unitDr.T. Balamurugan, PG
46 year old female, admitted in ICCU with c/o palpitation----------- 4 hrs
ECG
Heart rate- 190 Rhythm regular QRS duration- 60 ms R-R interval –regular & 320 ms P’ visible after QRS complexes R-P’ interval 80 ms (shortened)
DIAGNOSIS
Narrow complex tachycardia
Heart rate- 72/min Rhythm- regular QRS duration- 130 ms Slurred upstroke of QRS complex (delta
wave) P-R interval –90 ms (shortened) Q-T interval –480 ms
PAROXYSMAL TACHYCARDIAS IN WPW SYNDROME
AV junctional re-entry
tachycardia
•AV Junctional using anamolous pathway- 1) Orthodromic 2) antidromic•Intra nodal pathway (micro re-entry)•AV junctionl re-entry involving two anamolous pathways•Macro entry involving two anamolous pathways
Atrial tachyarrhythmi
a
•Atrial tachycardia•Atrial flutter•Atrial fibrillation
Ventricular tachycardia
MECHANISM OF RECIPROCATING TACHYCARDIA IN WPW SYNDROME
Sinus impulse activating atria (normal P wave)
conduction of sinus impulse
through bypass may be blocked, but conducted in usual manner through AV node, activating ventricles (normal QRS wave)
activation front on reaching ventricles, conducted retrogradely, activating
atria retrogradely
Retrograde P’ wave
Inverted P’ wave in L2,3,aVF
Returning reciprocal impulse, after reaching atria
Conducted anterogradely through normal AV nodal conduction, activating
ventricles
Re-enter bypass once again, activating atria……………
Reciprocating tachycardia
Since anterograde conduction to the ventricles occurs through normal pathway, pre-excitation doesn’t take place & delta waves not recordable
When ECG recorded during this phase, manifestations of WPW syndrome not evident in ECG ‘Concealed WPW syndrome’
THANK YOU