Short PR interval... possible cause of SOB?

[EC3]

Our team had a patient today: 28 y/o WM former collegiate swimmer with no past medical history who presented with 3 month history of SOB at rest and with exertion. Described the feeling as "not being able to get enough oxygen in." Denied syncope, cp, palpitations, asthma, cough, wheezing, and dizziness. Sat% was 98 on RA. HR 59, RR 12, BP 125/80. EKG was otherwise normal except for a PR interval of 100ms, no delta waves. Previous EKG from three years prior was normal, with PR interval of 143. Echo was unremarkable for abnormality.

My question is this. What would you guys make of the change in PR interval from previously being normal to now being shortened? My attending said it wasn't uncommon for people to have acessory pathways and said that such a pathway would not account for the patient's symptoms. He ended up referring the patient to pulmonary clinic for f/u, saying that the heart likely wasn't contributing to his symptoms.

Maybe i'm reading into the EKG too much but shouldn't there have been a bit more concern about the change in conduction abnormality? Is this really that common that it shouldn't be pursued further? Thx.

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[de-malady]

ok,
the pt is young with h/o being active athlete, there's less possibility for him to be a cardiac pt if we think this case in general; also his bp, pr, hr are normal..
ekg ruled out the cardiac ds, i suppose; though the saturation is 98%, pt had a 3 mts h/o sob both at rest & with exertion; what about the chest radiograpy, it might be crucial in this case, i'm sure.. [i'm in pulmonolgy rotation at present; will move to cardiology next wk]

may b you are being too sensitive on this case or yea like you have said of reading ekg too much.. just relax

 

[phillydoc]

Our team had a patient today: 28 y/o WM former collegiate swimmer with no past medical history who presented with 3 month history of SOB at rest and with exertion. Described the feeling as "not being able to get enough oxygen in." Denied syncope, cp, palpitations, asthma, cough, wheezing, and dizziness. Sat% was 98 on RA. HR 59, RR 12, BP 125/80. EKG was otherwise normal except for a PR interval of 100ms, no delta waves. Previous EKG from three years prior was normal, with PR interval of 143. Echo was unremarkable for abnormality.

My question is this. What would you guys make of the change in PR interval from previously being normal to now being shortened? My attending said it wasn't uncommon for people to have acessory pathways and said that such a pathway would not account for the patient's symptoms. He ended up referring the patient to pulmonary clinic for f/u, saying that the heart likely wasn't contributing to his symptoms.

Maybe i'm reading into the EKG too much but shouldn't there have been a bit more concern about the change in conduction abnormality? Is this really that common that it shouldn't be pursued further? Thx.

Your concern about short PR interval ( Preexcitation syndrome) seems not to correlate with the clinical picture of this guy.I would have been concerned if I would have seen dizziness or a profession which involve risk e:g bus driver etc etc, or have other EKG signs of Prexcitation syndrome like q waves or delta waves.However he might qualify for out patient exercise stress test to unmask a accesssory pathyway if he has one.

 

[ffpa3]

have you looked into Lown-Ganong-Levine Sydrome. Similar to WPW as it is a pre-excitation of the ventricles, but does not show any delta wave in the r wave progression. the PRI is less than 0.12sec as well. either way, more likely than not, benign to your patients case, but just figured it may solve what you were looking for

 

[howelljolly]

I think you're all bonkers.