You are in your office and are seeing a new patient. He is a 44 year old male who hasn't seen a doctor in a while because he just got insurance. He is here for a routine physical and would like his cholesterol checked. When asking him about his medical history he says that he has some condition that was diagnosed a long time ago and his old doctor told him there was nothing to do about it. His physical exam is normal. You decide to get an EKG to be complete. Here is the EKG what is you interpretation?

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Here is a simple routine EKG which revealed a very important piece of this patients history which he had obviously forgot. The EKG shows the typical findings for WPW. There is a short PR interval, notice in the leads with the Delta wave the PR is shorter than the the ones with out the obvious delta wave. That is why it is important to look at the entire EKG when reading the P-R interval. As mentioned already there is an obvious Delta wave in I and AvL. Due to the presents of WPW, the activation of the ventricle is different and hence can lead to false positives or false negatives for LVH or Left Bundle Branch Block. In this case the voltages are pretty high in I and AVL but with a normal blood pressure, it is likely a false positive due to the different activation of the ventricle by the accessory pathway.

There is also one Premature atrial contraction at beat #3.