7 Responses

  1. Prakrity Urja

    Agree with Zeeshan. There is QT prolongation. QTc 526.
    Along with it there is slurred upstroke of the QRS complex called WPW pattern or Delta waves.

    The delta waves are predominantly positive in precordial leads so it will be “type A” WPW pattern

  2. Roy

    Sinus Rhyt with QT prolongation. There is a notched T wave in V2 although criteria for long QT syndrome require evid of notched T in at leadt 3 leads. Agree with delta waves. Given history would also say prolonged QT syndrome with accessory pathway.

  3. Dr. Smer

    Great job everyone, few points

    1. As rule of thumb, drop a line half way between two consecutive R-R interval and if QT interval pass that line, suspect QTc prolongation.

    2. There 3 types of congenital QT syndrome. You all got it, this case is type 3, because there is long isoelectric ST-segment and T wave is relatively normal looking. Unlike type 1 long QT syndrome, when you have very broad base T wave and in type 2 long QT syndrome, you see low amplitude notched T wave.

    3. Although there is slurring in the initial upstroke of R wave in V2, suggest delta wave, remember the hallmark of WPW syndrome is short-PR interval and you can clearly see that PR interval is normal in this case. Also, it is very unlikely to have two syndrome in the same patient. This is (DBL) double back luck …!

    4. In RBBB, you see rSR pattern in V1-2 and deep S wave in leads I and V6. Usually, aVL is helpful in diagnosis of LBBB, not RBBB. In LBBB, you see tall broad notched R wave in aVL.

    Great job everyone


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