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.