A 19 year old with panic attacks. On the previous ECG, the diagnosis was missed, as it frequently is!

This young woman presented with recurrent anxiety attacks with chest pain and dyspnea.  She was otherwise healthy except for history of cholecystitis and cholecystectomy one year prior.I saw her in triage and ordered an EKG:What do you think?  How did I interpret this?There is a short PR interval.  The eye is taken immediately to the ST depression and T-wave inversion in multiple leads.  But as I pointed out in this recent post (I thought the ECG diagnosis was obvious. But many missed it. So I ' m showing it.) when there are ST-T abnormalities, one must look at the entire PQRST and look for reasons that the ST-T is abnormal SECONDARY to PQRS abnormalities.  Repolarization abnormalities may be entirely due to depolarization abnormalities.Again in this case, in addition to the ST depression and T-wave inversion in multiple leads, there is ashort PR interval, and anunusual delta wave in multiple leads.  There is a large R-wave in V1, with an RSr ' . This is another case of WPW.  WPW entirely explains the patient ' s symptoms, as WPW is strongly associated with (because it causes) episodes of SVT (or AVRT).  More technical: Where is the insertion of the accessory pathway?  The RSr ' in V1 is similar to RBBB, and indicates that the accessory pathway is on the left side, with the late forces to the right.  R-waves are positive throughout the precordium, indicating a probable posterior insertion of the a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs