ECG of the Week – 20th January 2021 – Interpretation

The ECG below has been taken from an 89 year old gentleman who has just transferred from the SJA stretcher to an ED bed. He has a history of prostate cancer, IHD and Aortic Stenosis and had an episode of central chest pain with an associated collapse but is now pain free.

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ECG of the Week – August 10th – Interpretation

The following ECG is taken from a 19 year old male who presented with shortness of breath and chest pain in the context of a current URTI.

On examination he looks well, his vital signs are as follows:

HR 80 BP 129/76 RR 16 Sats 97% RA T38.4.

 

Interpretation:

Rate – 84bpm

Rhythm – sinus arrhythmia

Axis – normal axis

Intervals – normal PR and QT intervals

Additional –

  • bifid p waves best seen in inferior leads
  • Voltage criteria for LVH
  • Up-sloping ST segments, best seen in the inferior leads, with no obvious ST segment elevation

Discussion: 

In the context of a current febrile illness and a patient presenting with chest pain, the top differential is a myopericarditis.

Serum troponin should be ordered to check for myocardial injury and, if positive, the patient should be referred to cardiology for admission and an echo.

Thought should also be given to underlying structural disease such as HCM in any patient with an ECG meeting voltage criterion for LVH.

Targeted history should be taken with regard to exertional chest pain, exertional syncope, exertional fatigue or dyspnoea.

However, this patient was an elite level athlete and some of these findings can be normal in athletic hearts.

Below are the most recently published guidelines regarding normal and abnormal findings in the interpretation of an ECG of an athlete. Familiarising yourself with these normal and abnormal findings can avoid high rates of false positive and unnecessary screening of otherwise well individuals.

Clinical closure:

This patient had a positive serum troponin and was admitted under cardiology and treated as a suspected viral myopericarditis. He had an echo which demonstrated normal cardiac function with no evidence of chamber enlargement or ventricular hypertrophy.

Further Reading:

https://litfl.com/hypertrophic-cardiomyopathy-hcm-ecg-library/

https://www.onlinejacc.org/content/69/8/1057

https://www.acc.org/latest-in-cardiology/articles/2019/07/17/07/03/athlete-ecgs

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6244896/