Abnormal ECG

[fromnc]

Hello.  I put this somewhere else, not sure if this is the right board or not.  My son will be 5 in a couple weeks.  I remember that the docs telling me in the past that he has a  murmur, but to keep an eye on it.  A few days ago my doc said he has a grade 3/6 over the 2nd intercoastal on rt. side.  My son has complained two times over the last few months that he was short of breath (which doesn't seem extreme to me). My doctor referred me to a pediatric cardiologist and told me to restrict his activity until we find out more.  We couldn't get in with the pediatric cardiologist for a month and a 1/2, so my doc ordered an echo and ekg.  We had those done today.  The ECG tech left the room and I looked at his ECG and it said abnormal ecg with sinus arythmia and probable rvh.  The rate was 64-90 with a v rate variation greater than 10%.  I managed to also write down upright t in v1 or v2.  I realize you're not my doctor, we will see one shortly and hear the test results soon.  As you can imagine, I am mortified with the thought of my healthy, active child suddenly being plagued with a heart problem.  Is it possible this could be benign or more possibly serious?  Thank you very much for your time.  Cindy

[fromnc]

Thank you.  My son has a completely normal heart, the EKG was messed up by the tech.  Have a good day!

[kenkeith]

QUOTE: " I remember that the docs telling me in the past that he has a  murmur, but to keep an eye on it.  A few days ago my doc said he has a grade 3/6 over the 2nd intercoastal on rt. side".

Heard with a stethoscope and the intensity of a murmur is graded on a scale of 1-6 (or 1-5). Each grade should be given in relation to the range used (e.g. grade 3/6). The grades are:
Grade 1: A quiet murmur that can be heard only after careful auscultation over a localized area.
Grade 2: A quiet murmur that is heard immediately once the stethoscope is placed over its localised PMI.
Grade 3: A moderately loud murmur, and there are grades 4,5, and 6 as well.

The tricuspid valve area is located in the third or fourth intercostal space on the right side of the chest.  An echo would rule out any structual abnormality such as bicuspid aorta valve (congenital abnormality) as well as mild-severe regurgitation (valve leaflets don't completely close over the valve opening causing blood to back flow into left ventricle..
irh: Right ventricular hypertrophy (RVH) is a rare condition, if it truly exists in your son's case. If the pulmonic valve is stenosed (narrow opening), RVH can develop from chronic pressure overload to the RV. Another cause could be infiltrative diseases like amyloidosis that cause the right ventricular walls to thicken (hypertrophy). However, both of these conditions are very rare. The normal response of the right ventricle to chronic pressure overload is to dilate since it's a much thinner walled structure than the left ventricle. The echo should have ruled that out by calculating chamber and wall diminsions.

Sinus arrhythmia: The normal increase in heart rate that occurs during inspiration (when you breathe in). This is a natural response and is more accentuated in children than adults. Rate 64-90 is not abnormal.  Normal HR is less than 100 at rest. EKG requires other tests to validate...the echo doesn't appear to substantiate the EKG output.

The "sinus" refers to the natural pacemaker of the heart which is called the sinoatrial (or sinus) node. It is located in the wall of the right atrium (the right upper chamber of the heart). Normal cardiac impulses start there and are transmitted to the atria and down to the ventricles (the lower chambers of the heart).



Sinus tachycardia refers to a fast heartbeat (tachycardia) because of rapid firing of the sinoatrial (sinus) node. This occurs in response to exercise, exertion, excitement, pain, fever, excessive thyroid hormone, low blood oxygen (hypoxia), stimulant drugs (such as caffeine), etc.

The lack of normal sinus rhythm is an arrhythmia, an abnormal heart rhythm.
The T wave is upright in I II and V2 to
V6. The end of the T wave should not
dip below the baseline. This is sometimes
seen in unstable angina.