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.

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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.