ECG Differential Diagnosis

Given the context of an ECG review for an individual planning to work abroad, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Normal ECG variant: This is often the most common finding in asymptomatic individuals undergoing pre-employment screening. A normal ECG does not necessarily indicate any pathology but rather serves as a baseline.
• Other Likely Diagnoses
  • Hypertension: Indicated by left ventricular hypertrophy (LVH) patterns on the ECG, which could be a concern for individuals about to undertake strenuous work or work in high-stress environments abroad.
  • Ischemic heart disease: ST-segment changes or Q-waves suggesting previous myocardial infarction could be relevant, especially if the individual is heading into an environment with limited medical access.
  • Atrial fibrillation or other arrhythmias: These could be detected on a screening ECG and have implications for the individual's health and work capability, especially in jobs requiring high physical exertion or precision.
• Do Not Miss Diagnoses
  • Wolff-Parkinson-White (WPW) syndrome: Although rare, this condition can lead to life-threatening arrhythmias. Its presence on an ECG is crucial to identify to prevent potential complications.
  • Long QT syndrome: This condition can predispose to torsades de pointes, a potentially fatal arrhythmia. It's essential to recognize the prolonged QT interval on the ECG to advise on necessary precautions and possibly treatment.
  • Brugada syndrome: Characterized by specific ST-segment elevations in leads V1-V3, this syndrome can lead to sudden cardiac death. Early identification is critical for preventive measures.
• Rare Diagnoses
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC): This condition can lead to life-threatening arrhythmias and is often identified by specific ECG patterns, including T-wave inversions in the right precordial leads.
  • Cardiac sarcoidosis: Although rare, it can cause various ECG abnormalities, including heart block and arrhythmias. Its diagnosis requires a high index of suspicion and further investigation.

Each of these diagnoses has implications for the individual's health and ability to work abroad, particularly in environments with limited access to medical care. A thorough evaluation, including clinical history and possibly additional tests, is necessary to confirm any diagnosis suggested by the ECG findings.