An adolescent with trauma, chest pain, and a wide complex rhythm

This case was sent by Dr Avinash Krishnamurthy, a fine emergency medicine resident from Australia Cairns base hospitalCase:An adolescent male had a mechanical fall and injured his left shoulder and arm. There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain. His chest was tender. A bedside cardiac ultrasound was normal.An ECG was recorded:Avinash was understandably confused by this ECG.He wrote:" ECG 1 - shows wide ???IVCD type rhythm ?? Delta waves in them and then his native rhythm, with ectopic pace maker?? "This was recorded shortly after:" Wide complex rhythm "This was recored seconds later:QRS are normal. P-waves are inverted with normal PR interval. This is low atrial rhythm.Here is my response:The QRS morphology looks like WPW, but it can ' t be because there are no P-waves, and when P-waves do appear, the QRS normalizes.I think this isaccelerated idioventricular rhythm, but with a slightly strange QRS.Accelerated idioventricular rhythm is a generally benign rhythm. It is commonly seen in the reperfusion setting. It appears to be benign in children as well (see references below).I sent it to my friend,Ken Grauer, who is very meticulous in his ECG reading. He has a great blog too:ECG InterpretationHe is also well known on theFacebook EKG Club page, where you can learn tons about ECGs:Here is his response, with the first ECG labelled:Hello Steve& Avinash.I agree completely with Ste...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs