Q. Had ECG for palpitations. Please have a look and assess further steps.

Answered by
Dr. Ilir Sharka
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Jun 09, 2019

Hello doctor,

I have a patient who is an athlete, has a history of panic attacks. Yesterday, he had palpitations, and some tingling was then sent for an ECG. The findings are sinus rhythm, marked right axis deviation, and ECG without any abnormalities. Would you be able to see it and assess what further steps I need to take?



Welcome to

I reviewed carefully your ECG images (attachment removed to protect patient identity) and would explain that besides right axis deviation, I also noticed the presence of prominent P waves in DII lead, which indicates a pattern or left the posterior fascicular block. For this reason, I would recommend performing a cardiac ultrasound to examine the heart and exclude possible structural abnormality.

Regarding the tingling, I would also recommend checking the thyroid hormone levels and blood electrolytes for possible imbalance. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need.

The Probable causes:

cardiac structural abnormality.

Investigations to be done:

Cardiac ultrasound.

Thank you doctor,

What kind of pattern do you notice? Should I be getting this person to the ER?



Welcome back to

I would not send him to the ER but would recommend avoiding strenuous physical activity until it is clarified that those ECG changes (large S waves in V1-V3 and axis deviation) do not correspond to any structural cardiac abnormalities. So, the next step is a cardiac ultrasound and if necessary a cardiac magnetic resonance imaging test.

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