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What does my EKG indicate ?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I would like for a doctor to look at a ekg, and tell me the results...I have a copy of it.

The person that took this EKG, was complaining of chest pain.
Posted Thu, 3 May 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 10 hours later

Thank you for your query.

The ECG shows a heart rate of 60/minute.

The rhythm is sinus rhythm.

There is NO first degree heart block. That is an artefact of automated analysis since the P wave voltage is low, the computer being unable to precisely note the beginning of P wave to calculate the PR interval. The actual PR interval is about 130 ms, but wrongly printed as 224ms. Normal PR interval ranges from 120 - 200ms and a value of 130 ms is normal, and thus, there is no first degree AV block.

The QRS axis is normal. The QRS duration and the QT interval are also normal.
The P wave duration in lead II is prolonged suggesting the possibility of left atrial enlargement. This may be a reflection of hypertension and age-related diastolic dysfunction of the left ventricle. This can be confirmed by echocardiography.

There are no abnormal q waves. The QRS morphology is normal. There is normal R wave progression. There is no ECG evidence of LV hypertrophy. However, the presence of COPD, emphysematous lungs, thick chest wall, etc may mask the increased voltage of LVH.

There is mild sagging of the ST segment in the lateral leads. In the presence of chest discomfort, it could be interpreted as mild ischemia. However, hypertension and changes secondary to hypertension may produce similar changes. In the elderly, it could also be a non-specific change. Clinical correlation as well as serial ECGs, cardiac enzyme testing and imaging are required to clarify matters.

T waves are normal. There is a normal u wave in lead V2.

Overall Impression:
Normal sinus rhythm.
Mild left atrial enlargement.
Mild ST sagging in lateral leads, needing clinical correlation/further testing.

I hope I have been able to answer your query.
Please feel free to get back to me for any further clarifications.

Dr RS Varma

Above answer was peer-reviewed by
Follow-up: What does my EKG indicate ? 9 hours later
Dear Dr. RS Varma:

Thank you por your explanation. The fact that PR intervals are wrongly printed as 224ms. Would this make a difference for a regular doctor to read this ECG, and find somenthing wrong with it? Is a mild ischemia a posibility of a heart attack? Would you send this patient home with Chest Pain withoud further testing.

Thank you.
Answered by Dr. Raja Sekhar Varma 2 hours later

Thank you for writing back to me.

It would probably take a doctor experienced in analyzing ECGs to note this. Generally, the automated values are accurate.

Ischemia is only one of the possibilities. As I said before, it could be changes due to hypertension and its effects on the heart muscle. The changes could also be non-specific. There is no evidence in the ECG to suggest a major attack.

Usually, serial ECGs are taken to clarify the issue. If old ECGs are available, they could be compared to see if the changes are fresh. Other investigative modalities like blood tests, echo, etc can also be done.

Most hospitals have standard protocols for evaluating patients with chest pain. They include a focussed history, clinical examination, ECG, observation, monitoring, blood investigations for cardiac enzymes, echo if required, etc. Based on the preliminary triage, further management is done depending on the working diagnosis and the differential diagnosis. If there is a suspicion of an acute coronary syndrome, the patient is admitted to a coronary care unit for further evaluation and treatment. If it is clearly a non-cardiac diagnosis with low risk of complications, the patient may be discharged.

I hope this clarifies your doubts.
Dr RS Varma

Above answer was peer-reviewed by
Follow-up: What does my EKG indicate ? 1 hour later
Dear Dr. RS Varma:

Thank you....for writing back.

The ECG I sent you, was taken on a Friday morning on the emergency room of a Clinic. and it is of my Mother. She was sent home with pain medication for muscular pain.

Saturday morning she complaing of the same pain, and she was taken to a Hospital emergency room...where they did another ECG, They told me that she was having a heart attack.

I won't go into details...but three days later she die of what it was called a Masive Hart attack.

That is why I need it to know from an scpecialist, if the first ECG did not have any concerens from a Medical point of view.

Thank you one more time, for all your explanation.


Answered by Dr. Raja Sekhar Varma 13 hours later
Hello ,
Please accept my heartfelt condolence at the loss of your mother.

It is well known that the initial ECG may not always show the changes of a heart attack in many cases. In such cases, serial and repeat ECG testing is needed to establish the diagnosis.

Blood tests like CK-MB and cardiac troponin become positive after approximately 6 hours after the onset of chest pain. If the blood tests are done too early, they also may be negative. Echo of the heart can show regional wall motion abnormalities which may help. Nuclear imaging is also possible to achieve a diagnosis in selected cases. Sometimes, angiograms may be needed and in such cases, emergency angioplasty also can be done to treat the heart attack.

Sometimes, there is increasing frequency of chest pain (called as crescendo angina) before it finally results in a major heart attack. Before the attack actually occurs, the ECG changes may be subtle or misleading, leading to a confusion about the diagnosis.

I hope I have been able to answer your doubts.

I wish you all the best,
Dr RS Varma
Above answer was peer-reviewed by
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