Baylor Health Care System: Wolff-Parkinson-White–type ventricular preexcitation mimicking left ventricular hypertrophy and an inferoposterior myocardial infarct

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Wolff-Parkinson-White–type ventricular preexcitation mimicking left ventricular hypertrophy and an inferoposterior myocardial infarct

D. Luke Glancy, MD

Since no abstract is available, the first 1800 words of the article are shown.

The electrocardiogram (Figure) meets at least two commonly used criteria for left ventricular enlargement: the R wave in V₅ or V₆ > 2.6 mV, i.e., >26 mm with the usual standardization of 1.0 mV = 10 mm (here RV₅ is 35 mm); and SV₁ + RV₅ or RV₆ > 3.5 mV, i.e., >35 mm (here SV₁ + RV₅ = 57 mm). Broad and deep Q waves in leads II, III, and aVF with broad and tall R waves in leads V₁ and V₂ are consistent with an inferoposterior myocardial infarct of indeterminate age. The patient’s age of 19 years, however, extends the limits of normal for SV₁ + RV₅ voltage to 60 mm (1) and makes myocardial infarction highly unlikely. Even more importantly, the electrocardiogram is typical of Wolff-Parkinson-White–type ventricular preexcitation, with a short P-R interval of 0.11 seconds, a long QRS duration of 0.12 seconds, and a delta wave visible in every lead except aVR and V₆. Delta waves are responsible for the Q waves in leads II, III, and aVF and the R waves in leads V₁ and V₂.