Explaining ECG and Clinical Findings to a Patient with Peripheral Edema
Your ECG shows mostly normal findings with some minor variations that are commonly seen in healthy people, and importantly, your heart is not the cause of the fluid in your legs. 1
Understanding Your Test Results
Normal Findings
- Normal sinus rhythm: Your heart is beating regularly at a normal rate and pattern 1
- No cardiopulmonary process on chest X-ray: Your heart size appears normal and there's no evidence of fluid in your lungs or heart failure 1
Minor ECG Variations (Likely Normal)
Incomplete right bundle branch block (RBBB): This is a minor delay in the electrical signal traveling through your heart's right side. In young people without other heart disease, this is often a normal variant and can even be related to lung capacity rather than heart disease 2. It does not require treatment 1
Minimal voltage criteria for LVH: The ECG shows borderline increased electrical signals that could suggest left ventricular thickening, but this is noted as "may be normal variant" because the R wave in lead aVL can be increased in normal individuals 3. True left ventricular hypertrophy would typically show additional ECG changes and would be confirmed by echocardiography 4
What's Causing Your Leg Swelling
Since your heart and lungs are not the problem, we need to investigate other causes of your leg edema. 1
Most Likely Causes to Evaluate
The fluid in your legs is most commonly due to 5:
- Chronic venous insufficiency: Poor circulation in leg veins (most common cause in older adults) 5
- Medications: Certain blood pressure medications (calcium channel blockers) and anti-inflammatory drugs frequently cause leg swelling 5
- Kidney disease: Requires checking kidney function and urine protein 1, 5
- Liver disease: Less common but should be excluded 5
- Low protein states: Malnutrition or protein loss 1
Required Next Steps
- Blood tests: Kidney function (creatinine, BUN), liver function, albumin/protein levels, electrolytes 1
- Urinalysis: To check for protein in urine (nephrotic syndrome) 5
- Medication review: Identify any drugs that commonly cause edema 5
- Physical examination focus: Check for varicose veins, skin changes suggesting venous insufficiency, liver enlargement, or signs of malnutrition 1, 5
Important Caveats
Do not start diuretics (water pills) without identifying the cause, as this can lead to dangerous electrolyte imbalances, dehydration, and falls, especially in older patients 5. The treatment depends entirely on the underlying cause—venous insufficiency requires compression stockings, medication-induced edema requires changing the drug, kidney disease requires specific management, etc. 5
If you develop shortness of breath, chest pain, or rapid weight gain, seek immediate medical attention, as these could indicate a change in your condition 1