ECG Review
History Is Everything
By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida . Dr. Grauer is the sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.
Scenario: Interpret the ECG above, obtained from a patient presenting to the Emergency Department. Is there any cause for concern?
Interpretation: The ECG shows sinus rhythm at 85/minute. The PR interval is normal. The QRS duration is upper normal (half a large box, but not more) and the QT interval is upper normal (about half the R-R interval, with a QTc ≈ 0.44 second). The axis is normal (+70°). There is right atrial abnormality (tall, peaked P wave in lead II ≥ 2.5 mm); possible left atrial abnormality (minimally deep negative component to the P in lead V1); and left ventricular hypertrophy (S in V1,2 + R in V5,6 ≥ 35 mm). Regarding Q-R-S-T changes, there is at most a tiny q in lead III, and transition is normal (between V2 to V4). The most remarkable finding on this tracing are the ST segments, which manifest at least 2 mm of J point elevation with straight (if not coved) takeoff in leads V2,V3. There is slight elevation with J point notching in lead V4. Missing from this presentation is the history and mention of prior tracings for comparison. At the very least we suspect multichamber enlargement and a probable cardiomyopathy. If the patient had new-onset chest pain, acute coronary syndrome with ST elevation would have to be ruled out. If ECG findings were chronic, ST-T changes from medication effect, early repolarization, cardiomyopathy, or some combination of these would have to be considered. History is everything in the interpretation of this tracing.
The ECG shows sinus rhythm at 85/minute. The PR interval is normal. The QRS duration is upper normal (half a large box, but not more) and the QT interval is upper normal (about half the R-R interval, with a QTc ≈ 0.44 second).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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