ECG Problem # 1

This ECG was recorded from a 20-year-old student who complained of an irregular heartbeat. Apart from an irregular pulse, her heart was clinically normal. What do the ECG and chest X-ray show and what would you do?

 

ECG 1

X-Ray 1

ANSWER

The ECG shows:

  • Sinus rhythm, rate 100/min
  • Ventricular extrasystoles
  • Normal axis
  • Normal QRS complexes and T waves

The chest X-ray is normal.

Clinical interpretation

The extrasystoles are fairly frequent but the ECG is otherwise normal.

What to do

Ventricular extrasystoles are very common. In large groups of people, there is a correlation between the presence of extrasystoles and heart disease of many types. However, in young people who are otherwise asymptomatic and whose hearts are otherwise normal, the chances of a significant cardiac problem are very low. In a young woman it is worth checking the haemoglobin level. An echocardiogram might set her mind at rest, but is not essential. The important thing is to advise her not to smoke and to avoid alcohol, coffee and tea.

Summary

Sinus rhythm with ventricular extrasystoles.

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