Question: EKG

B) Evidence of an accessory pathway
The ECG shows a delta wave, which is a slurred upstroke of the QRS complex (seen particularly in V3-V6 here), and a short PR interval, typical of Wolff-Parkinson-White syndrome, an accessory conduction pathway syndrome. Patients with WPW pattern are asymptomatic, while those with WPW syndrome develop tachycardic dysrhythmias. Asymmetric ventricular septal hypertrophy is seen in hypertrophic obstructive cardiomyopathy (HOCM) – the EKG findings include LVH and deep “dagger” Q waves in the inferior and lateral leads. ST changes and T wave inversions can indicate myocardial ischemia but are not seen here; the T wave in children after 4 days of age is normally inverted in V1-V3 and can remain so even into the 20’s. EKG findings in pericarditis include widespread concave ST elevation and PR depression in most leads.