From the Guidelines
This EKG interpretation of sinus bradycardia, low voltage QRS, and borderline ECG findings suggests the need for clinical correlation with the patient's symptoms and medical history to determine the underlying cause and appropriate management. The presence of sinus bradycardia, which is a heart rate of fewer than 60 beats per minute, can be normal in certain individuals, such as those who are physically fit or during sleep, but it can also indicate underlying issues like medication effects, hypothyroidism, or heart disease 1. The low voltage QRS complexes suggest reduced electrical signals through the heart muscle, which can be due to conditions like obesity, COPD, pericardial effusion, or infiltrative heart diseases 1.
Key Considerations
- The combination of these findings warrants further evaluation to determine the underlying cause and to assess for any potential cardiac or systemic disease.
- If the patient is experiencing symptoms like dizziness, fatigue, or shortness of breath, further cardiac evaluation would be recommended, including additional testing such as an echocardiogram, Holter monitoring, or thyroid function tests 1.
- Asymptomatic patients with these findings might simply need periodic follow-up ECGs to monitor for changes, but clinical judgment should be used to determine the best course of action based on the individual patient's risk factors and medical history.
Management and Next Steps
- Clinical correlation with the patient's symptoms and medical history is essential to determine the underlying cause of the EKG findings.
- Further testing, such as echocardiography or Holter monitoring, may be necessary to evaluate for underlying cardiac disease or to monitor for changes in the EKG findings over time 1.
- The patient's medication list should be reviewed to assess for any potential medications that could be contributing to the sinus bradycardia or low voltage QRS complexes.
From the Research
EKG Interpretation
The given EKG results indicate Sinus bradycardia, Low voltage QRS, and a Borderline ECG.
- Sinus bradycardia refers to a slower than normal heart rate, typically less than 60 beats per minute, originating from the sinoatrial node 2.
- Low voltage QRS is a condition where the amplitude of the QRS complex is lower than normal, which can be caused by various factors including peripheral edema, and has significant clinical implications 3.
- A Borderline ECG suggests that the results are not entirely normal but do not necessarily indicate a specific condition.
Clinical Implications
The presence of Low voltage QRS on an ECG can be a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction 4.
- Low voltage QRS has been associated with a higher rate of death and the composite end point of death or heart failure hospitalization in patients with systolic heart failure 4.
- Temporary transvenous pacing through the coronary sinus may be a novel approach to treat unstable bradycardia and reduce ventricular dyssynchrony, as seen in a case report where it stabilized blood pressure and improved end-organ perfusion 2.
Possible Causes and Associations
Low QRS voltage can be caused by cardiac and extracardiac factors, including peripheral edema, which can induce reversible low QRS voltage and alter various ECG measurements 3.
- The frequency of low voltage was higher in patients with advanced heart failure and was associated with a higher rate of adverse outcomes 4.