What do ST depression and atrial flutter on ECG mean?

Hi,

Welcome to icliniq.com.

I can understand your concern.

I cannot see the ECG (electrocardiogram) images here, so I will answer you the same way I would in the clinic when someone brings a tracing for interpretation.

Atrial flutter usually shows regular, narrow QRS complexes. Ventricular rate around 150 beats per minute in a 2:1 block. Saw tooth flutter waves, especially in leads II, III, and aVF. If your heart rate on the ECG is not around 150 and you can see normal P waves before each QRS, then atrial flutter is unlikely.

Now, regarding ST depression, it is at least 1 mm in the horizontal or downsloping direction. It is seen in two contiguous leads and sometimes associated with symptoms such as chest pain.

In a healthy 20-year-old male with no cardiac symptoms, true ischemic ST depression would be uncommon, unless there is a specific underlying condition. Mild upsloping changes or slight baseline variation are often misinterpreted by automated systems.

Early repolarization syndrome is very common in young healthy males. It typically shows J point elevation, concave ST elevation, rather than depression, and notching or slurring at the end of the QRS. Most prominent in precordial leads, it does not cause ST depression. So if anything, early repolarization produces mild ST elevation, not depression.

For the second ECG, without seeing it, I would assess heart rate rhythm, regular or irregular, presence of P waves, before every QRS width, ST segment pattern, and T wave symmetry.

At your age, common normal variants include sinus arrhythmia, early repolarization, and high voltage QRS due to a thin chest wall.

Your height and weight suggest a lean build, and that alone can produce prominent voltages that look dramatic but are normal.

Was this ECG done because of symptoms such as chest pain, palpitations, dizziness, or fainting, or was it just routine? Automated ECG interpretations are frequently wrong, especially in young adults.

The final interpretation should always be made by a physician reviewing the tracing directly. If you can describe the heart rate on the ECG, whether the rhythm was regular, and what the printed interpretation said exactly, I can help you reason through it clinically.

I hope this information will help you.

Thanks.

Hi,

Welcome back to icliniq.com.

I reviewed the uploaded image (attachments removed to protect the patient’s identity).

The heart rate of 130 beats per minute is indicative of tachycardia, and the regular rhythm with visible pointed P waves in leads II and III suggests sinus tachycardia rather than atrial flutter.

In true 2:1 atrial flutter, the ventricular rate is typically closer to 150 beats per minute with continuous flutter waves, and the presence of normal P waves rules out this diagnosis.

Regarding ST-segment analysis, true ischemic ST depression should be at least 1 mm in two contiguous leads, measured from the J point. Early repolarization, common in young, lean males, is characterized by J point elevation and does not account for ST depression.

Considering your age, lean build, normal previous ECGs, and symptoms labeled as musculoskeletal, sinus tachycardia appears to be the likely cause, possibly related to anxiety, pain, or other situational factors.

Be aware of any symptoms like rapid heartbeats, lightheadedness, or shortness of breath, as their absence reduces the likelihood of serious arrhythmias. Given the two normal ECGs and absence of significant risk factors, cardiac ischemia is highly unlikely. Please reach out if you have further questions.

I hope this helps you.

Thank you.