Electrocardiogram Questions

Specifically: Marked Sinus Bradycardia and early Repolarization

What’s the deal with early repolarization? Why is it bad. What are the long term consequences? Let’s say - hypothetically - that someone has the two things noted above. Why does it seem like this is something bad and abnormal and unhealthy, but at the same time it could also mean the person is in very good shape and just atheletic?
Also, anyone want to take a crack at explaining the rest of a hypothetical ECG?

Vent. rate 44bpm
(what is this? surely not ventilation. That would be hyperventilating. And if it is Ventricular[sup]?[/sup] Rate at 44 beats per minutes that is extremely low for a pulse…)
PR Interval 154ms
QRS Duration 102ms
QT/QTc 454/388ms
P-R-T axes 2 36 22
Anyone want to take a crack at all this?

ECG interpretation is a subtle science. The computers aren’t always good at seeing these subtleties and few emergency doctors or cardiologists rely on the “automatic” interpretation. The shape of the curves matter, and no one can see these over the internet. So I’ll discuss ECGs a little more generally than your specific case.

Ventricular rate is basically your heart rate. The heart is divided into two “top” quarters, the atria, and two bottom quarters, muscular pumps called ventricles. In some people the atria fibrillate (move very fast), so that the atria and ventricles are not moving at the same rate. But in most people, a ventricular rate of 44 is equivalent to a heart rate of 44.

“Sinus” means that your heart rhythm is regular. The ECG can be thought of as looking at 12-15 different areas of the heart, and looking at a few heartbeats at each of these areas. A normal heartbeat involves contraction of the atria, then the ventricles, then a pause where the heart rests and the heart muscle cells repolarize so that they can contract again in a short time. These process produce (respectively) P, QRS and T waves on the ECG. Looking at lots oif normal hearts, the amount of time that should occur between these waves has been standardized. The PR, QRS and QT intervals reflect how these waves are spaced. These values can be used to diagnoses many conditions: from first degree heart block, ventricular rhythms, digoxin or lithium poisoning, problems with potassium levels, etc. But the shape of the curve is more important than the number the computer analysis provides. The axes give an idea if the heart is too big, whch can be the result of many other problems.

http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/ekgecg.cfm

Basic ECG interpertation takes hours and hours of dedicated study to master. It is not easy to offer a precise explanation of it in this forum. The website above gives a few more details.

Bradycardia means that your heart rate is slower than average. This can be a result of medication (Beta-blockers, digoxin), efficency (the pump in some athletes works better and beats less often), disease (there is a block in the electrical system of the heart so that not all signals to beat are transmitted, etc.). Sinus bradycardia – a regular, low heart beat – is particularly concerning in the presence of chest pain, difficulty breathing, feeling faint or fainting, dizziness and lack of energy. It would be important to exclude a diagnosis of “sick sinus syndrome” where the signals to the heart alternate between too slow and too quickly since the signaller (the SA node) is not working properly.

http://www.emedicine.com/emerg/topic534.htm

The slow heart rate matters more than the “early repolarization”.