ECG Guru - Instructor Resources - Normal variants https://www.ecgguru.com/ecg/normal-variants en Normal ECG In A Young Adult https://www.ecgguru.com/ecg/normal-ecg-young-adult <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/normal-ecg-young-adult"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/N109.jpg" width="1800" height="1252" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG was obtained from a 24-year-old man who was seen in the Emergency Department for chest pain that was determined to be non-cardiac in origin.<span style="mso-spacerun: yes;">&nbsp; </span>He had a fever and cough, with pain on inspiration. His vital signs were within normal range, and he appeared well-perfused. There was no complaint of dizziness or syncope.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">So, what does his ECG show?<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>The ECG should be interpreted in the context of the age and presentation of the patient.<span style="mso-spacerun: yes;">&nbsp; </span>He is young, and has been healthy all his life.<span style="mso-spacerun: yes;">&nbsp; </span>He is lean and reasonably fit.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">The rhythm:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span>the rate is 81 bpm, and the rhythm is regular. <span style="mso-spacerun: yes;">&nbsp;</span>His P waves are upright in Leads I and II, and they are followed by QRS complexes.<span style="mso-spacerun: yes;">&nbsp; </span>The rhythm is NORMAL SINUS RHYTHM.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">Intervals: <span style="mso-spacerun: yes;">&nbsp;</span></span></strong>The PR interval is 137 ms (.137 seconds), and his QRS duration is 91 ms (0.9 seconds).<span style="mso-spacerun: yes;">&nbsp; </span>His QTc is 404 ms.<span style="mso-spacerun: yes;">&nbsp; </span>All are within normal range.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">QRS frontal plane axis:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong>Normal axis, at around 30 degrees.<span style="mso-spacerun: yes;">&nbsp; </span>Lead II has the tallest QRS of the limb leads, which is an indication of axis in the normal range.<span style="mso-spacerun: yes;">&nbsp; </span>When the electrical axis travels towards Lead II, we can expect Lead aVL to be small, or even biphasic.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">R wave progression:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp; </span></span>There is normal R wave progression in the chest leads, with V1 having an rS pattern (mostly negative) and V6 having an Rs pattern – nearly 100% upright.<span style="mso-spacerun: yes;">&nbsp; </span>Leads V2 through V5 progress from negative to positive in an orderly fashion, with the transition occurring in V3.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">ST segments and T waves: <span style="mso-spacerun: yes;">&nbsp;</span></span></strong>There are very slight J point elevations in Leads I and aVL – almost unnoticeable.<span style="mso-spacerun: yes;">&nbsp; </span>There are equally unimpressive ST depressions in Lead III.<span style="mso-spacerun: yes;">&nbsp; </span>The shape of the ST segments is almost uniformly concave upward, or “smiling”, with Leads aVR, III, and V1 the only exceptions. There are very tiny U waves noticeable in Leads V2 and V3.<span style="mso-spacerun: yes;">&nbsp; </span>There are T WAVE INVERSIONS in Leads III and V1 (right-sided leads), and of course, in aVR, which is a right-sided and superior lead.<span style="mso-spacerun: yes;">&nbsp; </span>aVR should look like an upside-down mirror image of a combination of Leads I and II.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong style="mso-bidi-font-weight: normal;"><span style="color: #00b050;">Interpretation:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span>Young people -<span style="mso-spacerun: yes;">&nbsp; </span>children, adolescents, and young adults – often have ECG features that would be concerning in older people, especially in those with cardiac symptoms.<span style="mso-spacerun: yes;">&nbsp; </span>It is important to know what ECG findings might be seen as normal variants in young people.<span style="mso-spacerun: yes;">&nbsp; </span>In this patient, the findings that might appear abnormal at first glance, but are normal variants, are:</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>U waves</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>T wave inversions in Leads III and V1.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>Slight ST elevation, or sometimes depression, in some leads.<span style="mso-spacerun: yes;">&nbsp; </span>In young men, especially, ST elevation can even be pronounced without signifying cardiac injury. To read an interesting discussion on Early Repolarization Syndrome, click <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282545/">HERE</a>.<span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">There are many other findings you may see in young people, though not in this one:</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>P wave changes such as bifid P waves in Lead II.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>Irregular rhythm – “sinus arrhythmia”.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;</span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>Tall voltages in left-sided chest leads.<span style="mso-spacerun: yes;">&nbsp; </span>“LVH without the strain”.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>*<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>Incomplete and complete right bundle branch block.<span style="font-size: 13.008px;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">This is a good ECG to use to remind your students to look at the whole picture – with patient presentation being very important!</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/733/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Normal ECG In A Young Adult 1/5</option><option value="40">Give Normal ECG In A Young Adult 2/5</option><option value="60">Give Normal ECG In A Young Adult 3/5</option><option value="80" selected="selected">Give Normal ECG In A Young Adult 4/5</option><option value="100">Give Normal ECG In A Young Adult 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >11</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-5F1e7vKkKDHS_jPQqdFfEjt3A8cyDmpL59xlezPAnag" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/normal-ecg-1" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Normal ECG</a></div><div class="field-item odd"><a href="/ecg/normal-variants" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Normal variants</a></div><div class="field-item even"><a href="/ecg/basic-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Basic ECG</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fnormal-ecg-young-adult&amp;title=Normal%20ECG%20In%20A%20Young%20Adult"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Mon, 19 Feb 2018 03:19:27 +0000 Dawn 753 at https://www.ecgguru.com https://www.ecgguru.com/ecg/normal-ecg-young-adult#comments