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Need help in reading ECG report. What is sinus rhythm?

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Practicing since : 1998
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I am a 39 yr old female and have been an active bulimic for 6 years. I had blood work and an ECG performed today. Please explain the ECG results for me. - BTW, I do not have shortness of breath or chest pain (they asked that) and I don't smoke or drink. My BP was 127/73. Please explain what the sinus rhythm is and what their concerns are. Also, please let me know if the numbers below are normal and if not, what a normal number would be. - Thank you so much :)
"Unconfirmed interpretation - MD should review sinus rhythm. Slight inferior repolarization disturbance, consider ischemia, LV overload or aspecific change. Small negative T in aVF with negative T in III. Borderline ECG.
P/PR: 123ms/180 ms
QRS: 98ms
QT/QTc/QTd: 435ms/444ms/-
P/QRS/T axis: 36/6/-4
Heartrate: 65 bpm
Posted Thu, 2 May 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 1 hour later

Thanks for the query. It may be a bit difficult to understand the all these findings without previous medical knowledge; however I shall try my best to explain them to you.

1. Sinus rhythm is normal rhythm. In our heart, there is a spot in right sided chamber (right atrium) which is known as SINUS NODE. Normally our heart beat starts from this point and spreads to whole of the heart in the form of an electrical current. So a normal origin of heart beat is named as sinus rhythm or sinus beat.
2. P wave is 123 msec, which means duration of P wave, is near normal. As we take 120 msec to be upper limit of normal P wave duration. It signifies time taken by electrical wave to cover whole of the both atria.
3. PR interval is time from onset of P wave to beginning of QRS. That is the time from beginning of current in atria and till the time it reaches the bigger chambers "ventricle". Normally it is 120-200 msec. hence it is normal in your case (180 msec).
4. QRS is 98 ms - that is the duration of QRS complex and it is normal. It is considered to be normal if it is less than 110 msec. It signifies time taken by electrical wave to cover whole of the both ventricles.
5. QTc is correct QT interval - the time from onset of activation of ventricle to recovery to basal state. Its normal value is ~ 440 msec for females and I consider this as normal value for you.
6. Your axis for P wave is 36 (normal is between 15-75 degree) and for QRS is 6 (normal between minus 30 to plus 90); hence both are normal.
7. T wave is inverted in lead III and AVF (but small). Without actually looking at it, it is not possible to make a firm opinion (like I would like to see more characters of T wave), however if you do not have high blood pressure, no chest pain on exercise /running, no shortness of breath on exercise / running, and no history of any cardiac event in past then the likelihood of this T wave inversion to be non-specific (non-pathological) is high. Nevertheless I would request you to show it to your cardiologist and be assured.

In brief, I find all your ECG findings assuring. If feasible, you may upload the scanned ECG record on this page using the site's uploader. I may be able to have a closer look.

I hope I explained your ECG findings to your satisfaction. Let me know if you need clarifications.

Dr. Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Need help in reading ECG report. What is sinus rhythm? 25 minutes later
Thank you so much for all of the detail you gave. It is very reassuring. - As for shortness of breath, I'm pretty out of shape so when do exercise, I am short of breath but I don't get stabbing chest pains. Also, sometimes when I vomit very aggressively, I get a chest pain into my shoulder (left side), but it goes away within a minute and I feel fine. ??? Should this be concerning? It's happened 2-3 times.
Answered by Dr. Sukhvinder Singh 12 minutes later
Dear Ma'am,

I have seen your ECG. Your ECG showed an asymmetrical T wave inversion in lead III only, which is ~1.5-2 mm deep. This is likely to be a non-specific isolated change, which is common in female subjects.
However since you have shortness of breath on exercise, I would like you to see your doctor who will assess you clinically including your weight & chest and heart findings, to suggest, if you really need a further work up for the same.

Pain while aggressive vomiting which goes away instantly is not cardiac.
Pain of heart disease is not stabbing in character. It is a kind of heaviness, as if someone has put a weight or stone on your chest, at times it is a feeling of being drowned.

For best cardiovascular prognosis, you must control your weight (ideal body mass index < 25).
I hope I cleared your doubts. If there is any more, please write to me, else, you may close the query.
Wishing you good health
sukhvinder Singh
Above answer was peer-reviewed by
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