Understanding Your Nondiagnostic EKG Result
Your EKG shows normal sinus rhythm at 65 bpm but is nondiagnostic due to baseline artifact, which means technical interference prevented accurate interpretation of the heart's electrical activity—this requires a repeat EKG with proper technique to obtain interpretable results. 1
What "Nondiagnostic" Means
A nondiagnostic EKG indicates that technical problems with the recording prevented the cardiologist from making any meaningful clinical interpretation, despite the visible normal heart rate. 1 The baseline artifact mentioned in your report represents electrical interference or noise that obscures the true cardiac signal. 2
Key points about baseline artifact:
- Common sources include muscle tremor, patient movement, poor electrode contact, electrical interference from nearby equipment (including warming blankets), or breathing-related motion 1, 2
- The artifact distorts the ECG waveforms, making it impossible to assess critical features like ST segments, T waves, Q waves, or conduction intervals 1
- This is a technical failure of the recording, not a cardiac abnormality 2
What Normal Sinus Rhythm at 65 BPM Indicates
The one interpretable finding—normal sinus rhythm at 65 bpm in Lead I—is reassuring and indicates:
- Your heart's natural pacemaker (sinus node) is functioning properly 3
- The heart rate of 65 bpm falls within the normal resting range of 50-90 bpm for adults 1
- The rhythm originates from the correct location in the heart 3
However, this single lead observation is insufficient for comprehensive cardiac assessment because a diagnostic EKG requires evaluation of all 12 leads to assess for ischemia, conduction abnormalities, chamber enlargement, and arrhythmias. 1
Critical Next Steps
You must obtain a repeat EKG with proper technique. 1 Here's the specific approach:
For the repeat EKG:
- Ensure you are warm, relaxed, and lying still for at least 5 minutes before recording 1
- Verify proper skin preparation and electrode placement 1
- Remove any electronic devices or warming equipment near the recording area 2
- Request the technician check for adequate signal quality before completing the recording 1
Clinical Context Matters
The clinical significance depends entirely on why the EKG was ordered:
If you have cardiac symptoms (chest pain, palpitations, syncope, dyspnea):
- A nondiagnostic EKG is unacceptable and must be repeated immediately 4
- In chest pain patients, 1-4% with completely normal EKGs have acute myocardial infarction, making clinical history paramount 4
- Never rely on an inadequate EKG to exclude cardiac disease when symptoms suggest it 4
If this was routine screening (preoperative, employment physical):
- The single visible normal sinus rhythm is encouraging 3
- Still requires repeat for complete evaluation 1
- A normal baseline ECG is associated with low risk of cardiac syncope and lower mortality 1
Common Pitfall to Avoid
Do not assume your heart is normal based on this result. 4 The report explicitly states "nondiagnostic," meaning no conclusions about your cardiac health can be drawn. 1 The visible normal sinus rhythm in one lead does not exclude:
- Myocardial ischemia or infarction 4
- Conduction abnormalities (bundle branch blocks, fascicular blocks) 1
- Chamber enlargement 1
- Repolarization abnormalities 1
- Arrhythmia substrate 1
Overreliance on an inadequate EKG in a patient with concerning symptoms is dangerous and can lead to missed diagnoses. 4
What Your Provider Should Do
Your ordering provider should:
- Order an immediate repeat EKG with attention to artifact elimination 1, 2
- Correlate the EKG findings with your clinical presentation and reason for testing 1, 4
- If you have any cardiac symptoms, proceed with evaluation as if no EKG was obtained 4
- Consider additional testing (echocardiography, stress testing, ambulatory monitoring) based on clinical suspicion regardless of the repeat EKG result 1, 5