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Having Chest Pain. ECG Without Significant Abnormalities. What Can De Wrong?

Posted on Fri, 31 May 2013

Question: .I am hoping you can help. For the last 3 weeks I have been having right sided chest pain most likely related to costocondritis or some type of muscle pull. I went to a walk in center today to be examined and the doctor did an EKG just to rule out any type of cardiac event. Although my chest pain does not appear to be cardiac in nature my EKG results were abnormal and I need to follow up with a cardiologist. I am a 31 year old male and do smoke. Outside of this I am reasonably healthy in regards to blood pressure etc. I have no family history of cardiac disease. Can you provide any guidance on the results. I am pretty freaked out at the moment. I am hoping the "ticker" does not stop. I attached a copy of the EKG.

Sinus Rythm
Marked left access deviation
Consistent with lafb.
Rsr in v2
ECG without significant abnormalities

P/pr 110/168 ms
Qrs 114 ms
Qt/Qtc 360/380 ms
P/qrs/t axis 25/-64/27 deg
Heart rate 67 bpm

Obviously I am thinking the worst case scenario. Any insight would be greatly appreciated. .

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

Dear XXXXXXX

Thanks for sharing your health concerns.

In terms of the EKG, it shows the normal rhythm of the heart, called sinus, in a regular fashion; there is no evidence of arrhythmia or chamber enlargement; if you have a slim body habitus (especially taller and thin) you can see some left axis deviation (just indicates the direction of the electric vector of the heart). Otherwise, there are no other changes that would suggest chest pain from obstructed heart arteries at rest.

Being a young cardiologist and an ex-smoker (short stint for 2 years), I can tell you that the smartest, best thing that you can do for your health is quit smoking; not a piece of cake task, but totally worth it, and easier now with supportive medications that your doctors can provide for cravings.

Hope this is useful, wish you and your family the best health,

Dr Brenes Salazar MD
Division of Cardiovascular Diseases
Mayo Clinic MN

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Jorge Brenes-Salazar (1 hour later)

thank you for the quick response. I am on day 2 of quitting smoking. gotta love the nicorette gum. in terms of the qrs duration of 114 is there any concerns with that? I read that it should be below 100.

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

Hi,

Thanks for writing back.

The cutoff for "normal" QRS is 0.10 ms, yours is .114 slightly above and that is why the mention the non-specific intraventricular conduction delay; at this moment it should be a benign finding when being an isolated feature.

Hope that is useful wish you the best health, keep strong with your quitting effort.

Dr Brenes salazar

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Jorge Brenes-Salazar (39 minutes later)

thank you. my biggest concern was the slightly long qrs with the left axis deviation. I spent to much time on Google and I thought it met the criteria for a bifasicular block. Is it safe to assume that my EKG does not show this?

Answered by Dr. Jorge Brenes-Salazar (1 hour later)

I agree with you, your ekg does NOT show bifascicular block, which is usually a combination of complete right bundle branch block and either a left anterior or left posterior fascicular block.

Hope that clarifies further.

Wish you the best health

Dr brenes salazar

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Prasad