ECG Quiz 032

FACEM VAQ Exam 2011.2 – Question 4

• The overall pass rate for this question was 31/81 (38.3%)
• Pass Criteria
  
• ECG Description to Include
  
  • SR, regular, rate 85 to 90 /min, left axis.
  • P waves normal with short PR ≤ 0.12, QRS ≥ 0.12 borderline widened, RSR V1and 2 – RBBB pattern
  • QTc normal ( 0.32 QT), Delta wave V2
  • ST depression V2 to V5 and T wave inversion inferior II, III, AVF and V1 to V5
  • Interpretation include sinus tachycardia short PR interval left axis RBBB pattern inferolateral ST,T changes presence delta waves
  • Re entrant arrhythmia secondary to aberrant pathway: WPW evidence by short PR, RBBB and delta wave – other most likely, DDx: Myocardial Ischaemia, Right heart strain e.g. PE
• Features of unsuccessful answers
  • In this answer candidates failed mostly due to an inadequate description of the ECG
  • Incorrect assumptions e.g. LBBB
  • Incorrect description of ST elevation
  • Incorrect axis
  • No mention or inadequate description of ST-T changes, rhythm, WPW
  • Incorrect diagnosis of STEMI and no mention possible ischaemia in differential diagnosis