WPW 3

WPW case 3.
Patient has both WPW (above) and LBBB at different time.

Patient. 53 year old male with cardiac history includes previous stent placement of the LAD lesion in 1999. He has been treated for dilated cardiomyopathy with ejection fraction of 30-35%. Patient was admitted this time for treatment of rapid heart beat. The WPW syndrome is not related to coronary artery disease.

I
V2

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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Go to predominant R wave in V1 (R/S ratio >1).
Go to axis deviation. Go to pseudo (infarction) Q wave.
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WPW case 3.
Patient has both WPW (above) and LBBB at different time.
Patient. 53 year old male with cardiac history includes previous stent placement of the LAD lesion in 1999. He has been treated for dilated cardiomyopathy with ejection fraction of 30-35%. Patient was admitted this time for treatment of rapid heart beat. The WPW syndrome is not related to coronary artery disease.
I V2	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)