What is the interpretation of an EKG showing normocardia, mild hypertension, slightly prolonged PR interval, and variable P, QRS, and T wave axes in an adult patient with potential underlying cardiac issues?

EKG Interpretation

This EKG demonstrates normal sinus rhythm with normal conduction intervals and axis, representing a completely normal electrocardiogram in an adult patient. 1

Heart Rate and Rhythm Analysis

• Heart rate is 72-76 bpm, which falls within the normal range of 60-100 bpm for adults 1, 2
• The rhythm is regular and originates from the sinus node, confirming normal sinus rhythm 1

Conduction Intervals Assessment

• PR interval of 134-146 ms is normal (normal range: 120-200 ms), indicating intact atrioventricular conduction without first-degree AV block 1, 2

  • While some studies suggest PR intervals ≥160 ms may have prognostic implications in specific populations, your values of 134-146 ms are well below any concerning threshold 3, 4
  • Rate-adjusted PR interval formulas are not necessary here as the raw PR values are clearly normal 5

• QRS duration of 89-92 ms is normal (normal <120 ms in adults), excluding any bundle branch blocks or intraventricular conduction delays 1, 2

• QTc interval of 394-395 ms is normal (normal <450 ms for men, <460 ms for women), indicating normal ventricular repolarization without risk for arrhythmias 1, 6

Axis Evaluation

• QRS axis of 55-65 degrees is normal (normal range: -30° to +90° in adults), with no evidence of left or right axis deviation 1
• P-wave axis shows some variability (32-106 degrees) but remains within acceptable limits, likely representing normal beat-to-beat variation or slight differences in measurement between the two recordings 1
• T-wave axis of 15 degrees is concordant with the QRS axis, indicating normal ventricular repolarization pattern 1

Blood Pressure Context

• Blood pressure of 126/88 mmHg represents stage 1 hypertension (130-139/80-89 mmHg per 2017 ACC/AHA guidelines) 1
• However, the EKG shows no evidence of left ventricular hypertrophy - no voltage criteria are met, no ST-T abnormalities suggestive of LVH, and normal QRS duration 1, 7
• The absence of ECG changes does not exclude early hypertensive heart disease, as ECG has poor sensitivity (6-50%) for detecting LVH 7

Clinical Significance

• This is a completely normal EKG with no pathological findings requiring intervention 1
• The mild hypertension noted in the blood pressure reading warrants blood pressure management per standard guidelines, but the EKG itself provides no evidence of target organ damage 1, 7
• No further cardiac workup is indicated based on these EKG findings alone - echocardiography would only be warranted if blood pressure reaches stage 2 hypertension (≥140/90 mmHg), symptoms develop, or other cardiovascular risk factors emerge 7

Important Caveats

• Always interpret the EKG in clinical context - a normal EKG does not exclude underlying cardiac disease, particularly early coronary artery disease or cardiomyopathy 1
• The variability in P-wave axis between the two recordings (32° vs 106°) is likely due to normal measurement variation or electrode placement differences, not pathology 7, 2
• Computer-generated EKG interpretations must always be verified by a qualified physician, as automated readings can contain errors 2