WPW 2

WPW case 2. (With LAD and pseudo infarct Q wave)

Note that PR interval (1) in lead II is also short. The QRS begin with broad and shallow Q wave, which is a delta wave.

Patient. 23 year old male was admitted for initiation of new medical treatment of his psychiatric condition. He is known to have WPW patern on his ECG without history of tachyarrhythmia.

II
III

Characteristic:
• Ventricle is excited through the accessory pathway sooner than normally excited through the normal conduction pathway, creating: (1) short PR interval (<120 ms), (2) Wide QRS, begin with Delta wave, (3) Abnormal (secondary) repolarization.
Other findings:
• Ventricular preexcitation may produce pseudo (infarction) Q wave (4), case 2.
• Ventricular preexcitation may produce abnormal QRS voltage, abnormal axis on frontal plane (LAD in case 2 and RAD in case 4), and abnormal QRS direction in precordial leads. (5) Predominant R wave in V1 (R/S ratio >1 in V1) in case 1 and case 4.
• Repolarization change may mask other cause of abnormal repolarization.
• May display varying degree of preexcitation, observed in the same patient. (Case 2 and Case 3)

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WPW case 2. (With LAD and pseudo infarct Q wave)
Note that PR interval (1) in lead II is also short. The QRS begin with broad and shallow Q wave, which is a delta wave.
Patient. 23 year old male was admitted for initiation of new medical treatment of his psychiatric condition. He is known to have WPW patern on his ECG without history of tachyarrhythmia.
II III	Characteristic: • Ventricle is excited through the accessory pathway sooner than normally excited through the normal conduction pathway, creating: (1) short PR interval (<120 ms), (2) Wide QRS, begin with Delta wave, (3) Abnormal (secondary) repolarization. Other findings: • Ventricular preexcitation may produce pseudo (infarction) Q wave (4), case 2. • Ventricular preexcitation may produce abnormal QRS voltage, abnormal axis on frontal plane (LAD in case 2 and RAD in case 4), and abnormal QRS direction in precordial leads. (5) Predominant R wave in V1 (R/S ratio >1 in V1) in case 1 and case 4. • Repolarization change may mask other cause of abnormal repolarization. • May display varying degree of preexcitation, observed in the same patient. (Case 2 and Case 3)