This post is an answer to the ECG Case 244
- Rate: ~42 bpm
- Rhythm:
- Complexes 1 and 2 are premature junctional complexes
- Remainder of ECG sinus rhythm
- Axis: Right axis deviation (RAD)
- Intervals:
- PR – Normal (~160ms)
- QRS – Normal (100ms)
- QT – 400ms
- Segments:
- ST elevation in leads aVF, V2, V3
- Additional:
- Biphasic T waves in 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 and healthy male
What happened next?
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.
READ MORE: Know the Differential for ST Segment Elevation: It’s More Than Just ACS
SIMILAR CASE: ECG Case 86: Benign Early Repolarization
