Saturday, 22 November 2014

ECG of the Week - 17th November 2014 - Interpretation

This ECG is from a fit & well 17 yr old male who presented to the Emergency Department with chest pain following a minor chest wall injury. Clinical examination revealed local chest wall tenderness at the site of trauma. Vital signs - BP, RR, Sats, Temp - were within normal limits. Chest x-ray was unremarkable and the pain resolved with simple analgesia. His 'routine' ECG is below.
Check out the comments from our original post here.



Click to enlarge

Rate:
  • ~42 bpm
Rhythm:
  • Complexes #1 & 2 are premature junctional complexes
  • Remainder of ECG sinus rhythm
Axis:
  • Right axis deviation
Intervals:
  • PR - Normal (~160ms)
  • QRS - Normal (100ms)
  • QT - 400ms
Segments:

  • ST elevation leads aVF, V2, V3

Additional:

  • Biphasic T waves leads V2-3
  • Precordial U waves also seen in aVF
  • RS complex in majority of precordial leads but with appropriate R wave progression


Interpretation:

  • Non-specific changes
  • Likely normal for young fit & healthy male


What happened ?

Given the patients benign history and a normal clinical exam he was discharged from the Emergency Department. The patient was advised to follow-up with his GP and have an out-patient echocardiogram to exclude structural abnormality.

Unfortunately the patient did not seek any further follow-up and never had an echo so I can't tell you what it showed. This does highlight the fact that many patients do not seek follow-up as advised once they leave the Emergency Department and should remind us of the need to communicate with our patients what we have found, what should happen next and why.