| Syndrome | ECG | Pathology | Clinical Significance | Images / References |
| Wellens | Proximal critical stenosis of LAD artery | Symmetrical deeply inverted T waves in V2-3 or Biphasic in V2-3 with minimal ST elevation.Changes occur in pain free state and normalise when pain | Acute anterior MI if untreated |  |
| Brugada | Sodium channelopathy.40% familial (autosomal dominant) | RBBB with ST elevation in V1-3. Convex and concave ST variants | Risk of sudden death, mandates urgent ICD |  |
| Wolff-Parkinson White | Pre-excitation syndrome.Re-entrant bundle of AV tissue distant to AV node. | Short PR interval; Prolonged QRS and slurred upstroke of QRS complex (Delta wave).“Type A” shows positive QRS in V1 (LV accessory). Upright positive delta wave in all precordial leads with a resultant R greater than S amplitude in lead V1“Type B” shows negative QRS in V1(RV accessory). Predominantly negative delta wave and QRS complex in leads V1 and V2 and becomes positive in transition to the lateral leads resembling LBBB. | Risk of Atrial arrhythmias being transmitted abherrantly causing VF or VT.Requires ablation of pathwayClinical Case WPW 001 |   |
| Mobitz II | A-V blockPR of constant interval | Constant PR interval until P waved dropped with P-P interval twice normal | Likely to progress to CHB |  |
| Wenckebach | A-V blockPR of increasing interval | Lengthening PR interval until P waved dropped with P-P interval variable. Grouped beats | Need follow up but less likely to progress to CHB |  |
| Lown-Ganong-Levine | Pre- excitation syndromeRe-entrant bundle of AV tissue close to AV node . | Accessory pathway is down James fibres.No Delta wave as conduction normal down Bundle of His | Risk of AF being transmitted abherrantly causing VF or VT.Requires ablation of pathway as WPW |  |
| Romano -Ward | Inherited Long QT syndrome (Autosomal dominant)Defect of Na and K channels.Not associated with deafness | Long QT, T wave alternans, notched T wave, R on T phenomenon, Torsades | Risk of Torsades. Electrolyte optimisation, may require ICD |  |
| Lange–Neilson and Jervelle | Inherited Long QT syndrome. Autosomal recessive defect of Na and K channels.Associated with neurosensorial deafness. | Long QT , T wave alternans, notched T wave, R on T phenomenon, Torsades | Risk of Torsades.Electrolyte optimisation, may require ICDAssociated with syncope, and sudden death | |
| Sgarbossa criteria | Derived from GUSTO 1 trial to identify MI in paced or LBBB patients | ST elevation >1mm concordant with QRS complex (5pts), ST depression >1mm in V1-3 (3pts), ST elevation >5mm discordant with QRS 2 points. >3 points consistent with MI | Help risk stratify patients with chronic LBBB presenting with ACS symptoms |  |
| Tako Tsubo | Cardiomyopathy with hypertrophic LV inferior and Hypotrophic superior wall (Octopus jar heart) | ECG changes as MI but usually brought on by stressful event | Normal angiogram but require cardiology follow up |  |
About Mike Cadogan
