Wolff-Parkinson-White Syndrome Blogs This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Chest pain in children – Cardiology Basics
Chest pain in children – Cardiology Basics Even though chest pain in children is a common symptom, unlike in adults it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents. A good history and physical examination can give a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis is a common cause of chest pain in adolescent and preadolescent girls. It can b...
Source: Cardiophile MD - October 13, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Chest pain and anterior ST depression. What ’s the cause(s)?
Written by Jesse McLaren, with edits from Smith and GrauerA 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. What do you think? I sent this to Dr. Meyers without any other information, and he responded, “do you have a prior to make sure that it is all just because of the delta wave? Would be careful to make sure it’s not inferoposterior OMI superimposed on baseline WPW.” In other words, when there are ST/T wave changes thefirst question is whether there ’s abnormal depolarization, because this will be followed by abnormal ...
Source: Dr. Smith's ECG Blog - October 13, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs

An Adolescent with dizziness and near syncope
Submitted by Maura Corbett, PA-C, written by Alex Bracey, with some comments by Smith and MeyersA teenage male presented to the emergency department with the complaint of dizziness with near-syncope. He was stable and able to provide a history and mentioned that he was asymptomatic while seated but dizzy and weak when attempting to stand. An ECG was recorded:What do you think? There iscomplete (third degree) heart block with wide complex bradycardicescape. The morphology is that of LBBB and so the escape is originating from the right bundle.The possible etiologies of this ECG are:- Structural/congenital heart di...
Source: Dr. Smith's ECG Blog - August 7, 2021 Category: Cardiology Authors: Bracey Source Type: blogs

Paradoxical splitting of second heart sound
Normal split of second heart sound is due to the delay in pulmonary valve closure compared to aortic valve. This is mostly contributed to by the pulmonary hang out interval. Hang out interval is the time taken for the actual valve closure after the pulmonary artery and right ventricular pressure tracings crossover. Normal split of second heart sound closes in expiration as the reduced venous return shortens right ventricular ejection. When the split closes in inspiration and becomes audible in expiration, it is called paradoxical splitting of second heart sound. Please note that a wide split of second heart sound as in ri...
Source: Cardiophile MD - June 20, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Role of adenosine in atrial fibrillation
First and foremost, it must be remembered that adenosine is not to be given in atrial fibrillation if there is an atrioventricular bypass tract (ventricular pre-excitation) like Wolff-Parkinson-White syndrome. This is because it slows conduction through the atrioventricular (AV) node, but does not affect the accessory pathway. Secondly, adenosine can rarely induce atrial fibrillation and very rarely ventricular fibrillation. Adenosine guided pulmonary vein ablation has been studied as adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction. Identifying dormant conduction will guide...
Source: Cardiophile MD - June 19, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Ebstein ’ s anomaly and pregnancy
Ebstein’s anomaly and pregnancy Ebstein’s anomaly of tricuspid valve was first described by Wilhelm Ebstein in 1866 [1]. It is characterized by distal displacement of the septal and posterior leaflets of tricuspid valve. Anterior leaflet is elongated and sail like. A portion of the right ventricle is ‘atrialized’ due to the distal displacement of the tricuspid valve. Right atrium is often grossly dilated. Right to left shunting occurs across a patent foramen ovale producing cyanosis of variable extent. Ebstein’s anomaly is one of the cyanotic congenital heart diseases in which survival to adul...
Source: Cardiophile MD - May 14, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Phenocopies of hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is characterized by hypertrophy of the left ventricle, not related to load. It is a genetically transmitted condition. There are several mimickers of hypertrophic cardiomyopathy which can be called phenocopies of hypertrophic cardiomyopathy. Conventional form of HCM has been called sarcomeric HCM as it is due to mutations in genes encoding sarcomeric proteins [1]. Here is a small list of phenocopies of hypertrophic cardiomyopathy which is not truly exhaustive: Fabry disease Danon disease PRKAG2 Cardiomyopathy Pompe disease Cardiac amyloidosis Athlete’s heart Hypertensive heart disease ...
Source: Cardiophile MD - February 24, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Mimickers of HCM Mimickers of hypertrophic cardiomyopathy Mimics of HCM Mimics of hypertrophic cardiomyopathy Source Type: blogs

A Clinical Scenario to Recognize- Irregular WCT
===================================MY Comment by KEN GRAUER, MD (3/12/2020):===================================A young adult presented to the ED with the “heart awareness” and the ECG shown in Figure-1 — but with no more than slight shortness of breath. BP ~ 130/70.QUESTIONS:What is the cardiac rhythm?How certain are you of your diagnosis?Is the clinical scenario consistent with what you might expect for this rhythm?Figure-1: The initial ECG in the ED (See text).ANSWERS: This young adult appears to be hemodynamically stable — since his BP is normal and hi...
Source: Dr. Smith's ECG Blog - March 10, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs

ECG Case 117
Dr John Larkin ECG Case 117 ECG of a 14yr old female who presents following an episode of palpitations and associated dizziness. Interpret her ECG using the Arruda algorithm (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - June 22, 2019 Category: Emergency Medicine Authors: Dr John Larkin Tags: Cardiology Pediatrics TOP 100 ECG Arruda algorithm EKG Milstein algorithm Wolff-Parkinson-White WPW Source Type: blogs

WPW Syndrome – the great mimicker
WPW Syndrome – the great mimicker WPW Syndrome the great mimicker Click here for a larger image This ECG shows sinus bradycardia with short PR interval and delta waves (black arrow in V5) indicating Wolff-Parkinson-White (WPW) syndrome. WPW syndrome is a great mimicker as shown in this ECG: Myocardial infarction: Negative delta in inferior leads (blue arrows) may be mistaken for pathological Q waves of old myocardial infarction. Right ventricular hypertrophy: Tall R waves in V1, V2 (red arrows) may be mistaken for right ventricular hypertrophy. Left ventricular hypertrophy: Tall R waves in V5 (violet arrow) may be ...
Source: Cardiophile MD - March 21, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

ECG in Ebstein ’ s anomaly of tricuspid valve
ECG in Ebstein’s anomaly of tricuspid valve ECG in Ebstein’s anomaly of tricuspid valve ECG in Ebstein’s anomaly of tricuspid valve showing right axis deviation of QRS, notched R waves in II, III, aVF and V1 suggesting fragmented QRS. Peaked P waves indicate a right atrial abnormality, though the typical voltage criteria for right atrial enlargement (more than 0.25 mV) is not satisfied. Fragmented QRS occurs in Ebstein’s anomaly due to abnormal conduction in the atrialised right ventricle [1]. A portion of the right ventricle is atrialised because of distal displacement of the septal and posterior ...
Source: Cardiophile MD - January 26, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library fragmented QRS Source Type: blogs

ECG Quiz 4 – Discussion
Discussion ECG Quiz 4 Discussion At one look it may look like left ventricular hypertrophy with strain pattern as there are tall R waves in lateral leads with ST segment depression and T wave inversion. One might think of old inferior wall infarction in addition as there is a prominent ‘Q’ wave in lead III and a smaller one in aVF. Some may even consider right ventricular hypertrophy in view of dominant R waves in V1, V2. But if you go by the standard sequence of ECG interpretation – P, PR interval, QRS, ST segment and T wave, it becomes obvious that PR interval is short. In many leads, the slurred initia...
Source: Cardiophile MD - November 16, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs

12 Year Old Asthmatic with Intermittent Dyspnea Unresponsive to Albuterol---What is it, and Why Now?
This case was written by one of ourgreat Hennepin 2nd year residents, Aaron Robinson, with lots of comments and edits by Smith.Thanks to Dr. Smith and Dr. Travis Olives for being part of this case. A 12 year old girl with a history of mild intermittent asthma presented to the emergency department with worsening shortness of breath over the past couple of days. She is up to date on her vaccinations and has no PMHx besides asthma and a noncontributory family history. She does not identify any specific triggers for her asthma. Initial screen in triage revealed normal vitals signs and a normal temperature. Upon interviewi...
Source: Dr. Smith's ECG Blog - August 7, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Adenosine and ventricular fibrillation
Adenosine induced ventricular fibrillation has been reported in two situations: During intracoronary administration for assessment of fractional flow reserve (FFR) Intravenous administration in an attempt to identify the mechanism of wide QRS tachycardia Adenosine induced ventricular fibrillation during FFR estimation Three cases of ventricular fibrillation (VF) during intracoronary administration for induction of maximal hyperemia was observed by Shah AH et al [1]. They could prevent future occurrences by doubling the concentration in order to reduce the volume of injection by half. Similar instance of adenosine indu...
Source: Cardiophile MD - August 11, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Source Type: blogs

Wide Complex Tachycardia
An otherwise healthy woman in her 20's with no past medical history presented with tachycardia. She had experienced palpitations and called 911. Prehospital rhythm strips were at a rate of at least 200 (unavailable) and the medics gave adenosine at both 6 mg and 12 mg with no effect. She was stable, with no CP, SOB, hypotension or evidence of shock.Here is the initial ED ECG:What is the diagnosis (this is pathognomonic)? See below. (Notice that the computer incorrectly read ***Acute MI***)1. The rhythm is irregularly irregular, therefore it is atrial fibrillation2. The complexes are wide (so on...
Source: Dr. Smith's ECG Blog - March 28, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs