I’m a medical student and had an ECG done recently in hospital. It shows a rate of 40, LVH (47mm by Sokolow-Lyon), T-wave inversion in V1 and a bit of high take-off. I train a fair bit so none of these surprises me particularly. The one finding I’m not clear on is a small U-wave, visible V2-V5. From what I’ve found to read, it seems to be associated with electrolyte imbalances, thyrotoxicosis, a few drugs and long QT syndrome. As far as I’m aware, none of these would apply in my case, though my QTc is always borderline long (right around 440).
I appreciate it’s difficult to comment on my particular case via internet but, more generally, is this a relatively common finding? Is it associated with athletic training? Is presence of a small (~1mm) U wave associated with any known risks?
Many years ago while in paramedic school I found the same issue with my EKG readings. I had some concern and basically asked the same questions. Why am I not normal? Like I said it was many years ago and after chasing this question around to anyone who would listen,without personally seeing a Cardiologist in an appointment, the best answers that I got was don’t worry about it. If I remember correctly it had to do with my very slow rate(40-44 beats per minute) and repolarization. I have lived more than a decade and a half with no issues, continued improvement in race times and would have forgotten about it until I read your post. I would still like to get an official reason but who would be the specialist. Sports medicine Electrophysiologist? Somebody must have the knowledge, too bad it isn’t me! Good luck.
I’m not a cardiologist but:
while not seen in all people, u waves are normal.
prominent u waves can be seen in people with low potassium. Probably other electrolyte abnormalities can contribute, but I’m not aware of them. Long QT is also associated with low potassium, but you’d also get pr as well as QRS prolongation as well as prominent u waves. I find the machine doesn’t interpret QTc very accurately, especially if you’ve got u waves. It’s normal for the QT to prolong with bradycardia, and 440 is fine- better off to calculate it yourself, if you have access to the ecg.
Repolarization abnormalities ie high take off, are commonly found in V1 and V2- don’t worry you’re not having a STEMI. Similarly, flipped T-waves are fine unless they become unflipped in the same lead.
BTW i use estes for LVH.
hope this helps
d.
ps:There’s a reason why docs make the worst patients
I don’t have a clue what you are talking about, but if a bonafide cardiologist or two was not concerned and they knew about your training, then great. If not, see another cardiologist and be very clear with your questions. I have had some abnormal EKGs and ECGs I can understand being a little frightened and hoping that a cardiologist with an athletic bent might send some soothing words your way…and maybe that will happen.
Here’s what I can tell you based on my own layperson’s experience…ECGs are somewhat inaccurate. Sound waves bounce off of your rib cage and other internal organs and can cause abnormal readings…maybe the technician just finished their certificate program and did the test poorly…maybe you had too much coffee or were dehydrated or just nervous because you were having an ECG!
I had such abnormal tests that were suggestive of such a serious issue that I ended up having to have a TEE and from what I understand, this test is pretty darn accurate without having them actually cut you open and examine your heart in person. If you see a cardiologist and they recommend this, go for it (hope you have good insurance, it ain’t cheap)…but then you will know. I was absolutely astounded in how much the uncertainty sapped my energy and caused all kinds of mystery chest pains and other issues. Then I got a clean bill of health and poof all of the other symptoms were gone. I am able to focus on life again.
Reading comprehension people…When you are in Med School you get your own ECG done to practice interpretation. He is NOT asking for a diagnosis, just a question. I go to Med School as well and don’t see any cardiologists walking around the halls, they got way more important things to do. Like go on triathlon message boards and diagnose people on the internet…
Thanks for your comments. I have run my ECG past a consultant cardiologist who specialises in cardiomyopathy, who I happened to be working with at the time of the ECG. He told me that, for me, my ECG was probably normal. Unfortunately, the line between normal findings attributable to athletic training and abnormal findings attributable to pathology is not always clear. The best answer I could get about U waves was that they may be associated with papillary muscle repolarisation, but that not much is known about them. He wasn’t concerned with my ECG, and neither am I.
If you actually read my post, rather than reacting emotionally (didn’t mean to drive you “bananas”), you’ll realise that I didn’t ask for a comment on my particular case. I specifically wrote that most of the findings on my ECG were not surprising (i.e. not worrying) and that the only one I wasn’t sure about was the U wave. I then asked for a general comment on U waves and their significance, rather than a specific comment on the significance of a U wave in my particular case, which is of course inappropriate on a message board.
I know there are several doctors who regularly post on this board, so it didn’t seem unreasonable to post a question and see if a cardiologist happened to read it and reply.
I apologize. I am a pediatrician and sports medicine physician. I look at maybe 20 ECG’s per year tops. Presence or absence of any deflection between T and P doesn’t usually make my radar. I have never received a report from a cardiologist describing a concerning U wave or any need for further work up because of their presence.
why does everyone on here have to be such an asshole? If med school is such an easy admit, then why the hell aren’t you in there? The guy asked a legit question, gets a decent response, and you act like a dick for no f’n reason. WTF man? Quit being pissy for no reason. You and Learn need to “learn” a lesson in manners.
Fucking Aye man. Let me see you diagnose anything other than a seat that’s “too high”.
No I wasn’t being an asshole. Maybe you need reading for comprehension. In his OP he did not specify anything about the med students having ECGs as part of their course of study - - he assumed the rest of the population to be psychic on this one and turtlesam was a total dick about my response and now you are being a total dick because I was putting another total dick in his place…so why don’t you total dicks go and play with each other.
I’m not in med school because I pursued a different career - - one that I must be good at since it pays for my expensive hobby and one that is quite beneficial to society since it provides great housing for working class stiffs. There are other worthy careers outside of medicine…FYI.
I was not being an asshole in my previous posts, just stating the facts. This is being an asshole: Not only am I clearly more intelligent than you judging by your 8th grade writing abilities, I am also a much faster triathlete and probably better looking as well.
"I’m a medical student and had an ECG done recently in hospital. It shows a rate of 40, LVH (47mm by Sokolow-Lyon), T-wave inversion in V1 and a bit of high take-off. I train a fair bit so none of these surprises me particularly. The one finding I’m not clear on is a small U-wave, visible V2-V5. From what I’ve found to read, it seems to be associated with electrolyte imbalances, thyrotoxicosis, a few drugs and long QT syndrome. As far as I’m aware, none of these would apply in my case, though my QTc is always borderline long (right around 440).
I appreciate it’s difficult to comment on my particular case via internet but, more generally, is this a relatively common finding? Is it associated with athletic training? Is presence of a small (~1mm) U wave associated with any known risks?
Thanks for any help. "
To which I responded, very politely, with what I know… He pretty clearly asks if it is know to be associated with risks…silly me for thinking that it might be worrying him and that he might want a “diagnoses” of said risks from athletes who have had heart issues - - I mean if he were looking for medical opinions, clearly a triathlon message board is the place to go! Silly me for suggesting that if it is really bothering him…seeking a more sophisticated test or a second opinion from a bonifide cardiologist was the way to go! Silly me!!
Your Posts (both directed at me):
"Reading comprehension people…When you are in Med School you get your own ECG done to practice interpretation. He is NOT asking for a diagnosis, just a question. I go to Med School as well and don’t see any cardiologists walking around the halls, they got way more important things to do. Like go on triathlon message boards and diagnose people on the internet… "
* "* I was not being an asshole in my previous posts, just stating the facts. This is being an asshole: Not only am I clearly more intelligent than you judging by your 8th grade writing abilities, I am also a much faster triathlete and probably better looking as well. "
Please show me where in his post it says that he got the ECG as part of his med school studies and not as many lay people might assume, because he was having some issue that prompted him to go get the test??? Reading comprehension or psychic ability???