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Abnormal ECG in a 35-Year-Old Man
By Ken Grauer, MD
|Figure. 12-lead ECG recorded from a 35-year-old man.|
Clinical Scenario: The ECG in the Figure was obtained from a 35-year-old man. Is it abnormal? What do you want to know?
Interpretation/Answer: There are a number of remarkable findings on this tracing. The rhythm is fairly regular but quite slow. The R-R interval is at least 8 large boxes, corresponding to a heart rate of less than 40/minute. An upright P wave is seen for the single beat that is recorded in lead II, but the PR interval is very short. QRS voltage criteria for LVH (left ventricular hypertrophy) are present, and Q waves are seen in the lateral leads. There are no acute ST-T wave changes.
The key to interpreting the clinical significance of this ECG lies with the history. The patient in question is an otherwise healthy 35-year-old man who is on no medications, and who is completely asymptomatic. He obtained this ECG as part of an ETT (exercise treadmill test) that he wanted done as an indicator of his fitness level. His exercise capacity on ETT was excellent as expected, and he had a completely normal blood pressure and ST segment response to exercise. Rhythm strips obtained before and after exercise demonstrated sinus bradycardia and arrhythmia, intermittently with a normal variant wandering atrial pacemaker. The 12-lead ECG shown here shows one of the atrial foci from his wandering pacemaker that happens to have a short PR interval. Echo demonstrated a normal heart in this athletic young adult. Conclusion: Clinical correlation is everything, and remember to insist on having a rhythm strip before concluding that an ECG rhythm on a 12-lead tracing is abnormal.