An 10 year old male presents to ED post a syncope. Below is the boys ECG:
- Describe and interpret the ECG
- What specific ECG changes do you look for in a patient that presents with syncope?
Answer:
Rate:72 beats per minute
Rhythm: normal sinus rhythm
Axis: Normal axis
Intervals
- PR 160ms
- QRS 80ms (70-90ms normal for age group)
- QT 394ms (Bazett Formula)
Additional:
T wave inversion V1-V3 (likely persistent juvenile pattern)
Deep narrow Q waves inferolaterally
Tall R and deep S waves but all in keeping with the childs age
The above ECG is of a 10 year old child. Some features can be normal for the childs age – T wave inversion V1 -V3, Tall R wave and deep S waves. The ECG shows no signs of left ventricular hypertrophy (given age criteria) but very deep Q waves (dagger waves) suggestive of hypertrophic cardiomyopathy.
When interpreting an ECG in a patient with syncope the following should be looked for:
tachy/bradyarrythmia
Shortened PR/Delta waves – WPW
Prolonged QT
Signs for PE – sinus tachy, right heart strain
Signs for HCM – LV enlargement (voltage and nonvoltage criteria) and dagger waves
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