mechanism of this EKG.........q? - jamebond

[ArchivalUser]

Also,I do not see any ST changes,they are horizontal -in they way they should be.Let me look that AVL one more time and see...
Antonella

[ArchivalUser]

i think it WPW
but it's not clear as jamebond said
but i can tell there is short PR and delta wave may be clear more in lead AVL.
and wide QRS in some leads.
thanks

[ArchivalUser]

Sorry, friends........forget about that and look at this
http://img101.imageshack.us/img101/6185/f1large.jpg
what is the mechanism of this EKG?........thanks

[ArchivalUser]

@antonella: if you take close look at the first ecg, you'll notice that there is slur(delta wave) in leads 1, V2-v6 along with short P-R interval. The rest of the changes are associated with the old inferior MI but wont lead to any complications.

the second ECG is also WPW and the mechanism is that there is an accessory pathway through which the impulses pass on to the ventricles bypassing the av node. That is why rate limiting drugs(esp B-blockers) are contraindicated in wpw b'cos they suppress the a-v nodal conduction which causes the accessory pathway to over-ride the a-v node and thus eventually causing arrythmia.
the only treatment is ablation therapy.

[ArchivalUser]

Hi Joeblack,
On the second one,I can see clear delta wave-yes.Now, the definitive treatment is ABLATION,but what is the first initial Rx??
Antonella

[ArchivalUser]

Adenosine!

[ArchivalUser]

Yap,adenosine is the first initial step in menagment.
Antonella

[ArchivalUser]

Actually, I don't see prolongation of PR interval on this EKG. You know if PR> 3 small sq. it would be considered prolong. Here it looks to me even less than 3 small sq., right?

[ArchivalUser]

Dx: WPW syn
Mechanism: accessory conduction pathway from atria to ven(bundle of Kent), bypassing av node
Compli: SVT

[ArchivalUser]

Again for the second EKG:
"There are deltas everywhere and also looks like PR interval is shortened too which would go with WPW. The ST segments are "sagging" in V4,5,6 but its not true ST depression because : there is no clear 'j' point (point or angle of deviation) and the "sagging" is less than 1mm which is criterion for clinically significant ST dep. Bottomline- no ST dep.""
Yes SVT is compication of WPW and the Rx for SVT firs carotid massage ,than adenosine and the final Rx is ablation
!!!!
For the first EKG:
"there is no ST dep in lead II and aVL. Don't look at the first beat in aVL (that's artifact) , look from the 2nd cycle onwards in aVL. There is T inversion there though. But we normally ignore avl."
Antonella