Identify the ECG patterns that can be mistaken as abnormal. RSA = Respiratory Sinus Arrhythmia: change in R-R interval from respiration shortened during inspiration and prolonged during expiration, physiologic to match ventilation and perfusion. VAGO = Pronounced VAGOtonia in athletes: sinus bradycardia, first degree AV blocks, supraventricular and ventricular ectopic beats. These do not require attention if they are asymptomatic or do not produce pauses greater than 4 seconds. Ectopic beats are no more frequent in athletes than the general population. BER = Benign Early Repolarization: isolated J point elevation. ST/T ratio is < 0.25 and normalizes with isoproteronol or exercise (used to distinguish from pericarditis). IRBBB = Incomplete Right Bundle Branch Blocks: QRS < 0.12 seconds, seen in patients with skeletal abnormalities. PJTW = Persistent Juvenile T-Wave pattern: T-wave inversion in V1-3, but upright in other leads. The T vector is oriented left and posterior from heart orientation in chest. Seen also in potassium deficiency, vagotonia, hyperventilation. PHT = Physiologic HyperTrophy: adaptation from static or dynamic exercise. Common variants are increased voltage, prominent U waves, intraventricular conduction delays, early repolarization, increased QT intervals. PROM-T = PROMinent T-wave amplitude: T waves tall but not symmetric, seen in vagotonia, hyperkalemia, anemia. STD = ST segment Depression: seen in excess sympathetic activity, hyperventilation, neurocirculatory asthenia. QW = Q Waves: seen in vertical or horizontal heart/chest abnormalities/elderly. Lack of multiple leads with Q waves differentiates normal variants with old infarctions. PRWP = Poor R-Wave Progression: differentiate old anterior MI with the presence of Q waves. ASYM = ASYMptomatic patient. SYM = SYMptomatic patient: patient who reports significant symptoms (especially with exercise), including chest pain, dyspnea, presyncope/syncope, or palpitations. REASS = REASSure patient and tell them they likely have a normal variation on their ECG, and they should be fine; if they develop any symptoms, return for reevaluation. ECHO = Order an ECHOcardiogram to rule out significant structural heart disease. STR-ECHO = Order a STRess ECHOcardiogram to rule out structural as well as functional problems that might be leading to their symptoms. |