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Differential Diagnosis

  • First-degree AV block
  • Wolff-Parkinson-White syndrome(WPW)
  • Anterior ischemia
  • Posterior MI
  • Persistent juvenile T wave pattern

 

Diagnosis

This ECG shows normal sinus rhythm with a rate around 80. Regarding the possibilities listed in our differential diagnosis above, the normal PR interval is 120-200 ms, with first-degree AV block being a duration longer than 200 ms (not present on this ECG).

WPW is defined by a short PR, a delta wave, and a wide QRS complex, which is not present here.

Could this be an anterior ischemia? There is T wave inversion anteriorly, but this does not make sense with the clinical picture. Additionally, there is no ST elevation.

How about a posterior MI? There is no ST depression in leads V1-3, as well as no clinical story consistent with ischemia or infarction.

The correct diagnosis is persistent juvenile T wave pattern, which is a normal variant.

 

Acknowledgement: Case adapted from Academic Emergency Medicine Education Masters. MedEDMasters. Persistent juvenile T-waves. Available at: http://www.mededmasters.com/peristent-juvenile-twi.html. Accessed April 10, 2019.

 

 

 

 

 

 

 

 

 

 

 

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