24/M ,interpret this ECG. A case of Fever X3days, dry cough , vomit -2epi, retroobribal pain and headache,
Reading File
The ECG image is upside down (the paper appears inverted), so I'll read the machine-printed parameters directly and analyze those alongside the visible waveform morphology.
ECG Interpretation — 24M, Febrile Illness
Machine-Read Parameters (GE MAC 2000)
| Parameter | Value |
|---|---|
| Rate | 93 bpm |
| Rhythm | Normal sinus rhythm |
| P/QRS/T axis | 50° / 75° / 33° |
| PR interval | 136 ms (normal) |
| QRS duration | 82 ms (normal, narrow) |
| QT / QTc | 332 / 412 ms (normal) |
| P / PP | 642 / 565 ms |
| Machine interpretation | Abnormal ECG — Nonspecific T-wave abnormality |
Systematic Interpretation
Rate: 93 bpm — sinus tachycardia range (just below 100), consistent with fever.
Rhythm: Regular sinus rhythm — each QRS is preceded by a P wave with constant PR (136 ms).
Axis: Normal axis (QRS 75°).
Intervals:
- PR 136 ms — normal (no AV block, no pre-excitation)
- QRS 82 ms — narrow (no bundle branch block)
- QTc 412 ms — within normal limits (no QT prolongation)
Key Finding — Nonspecific T-wave abnormality:
The machine flags nonspecific T-wave changes. In the context of this clinical picture, the likely causes are:
- Fever-related repolarization changes — the most common and benign cause; tachycardia and metabolic stress from fever flatten or invert T waves, particularly in precordial leads.
- Electrolyte disturbance — vomiting (×2 episodes) can cause hypokalemia or hypomagnesemia, both of which flatten/invert T waves and prolong QU interval.
- Early viral myocarditis — dry cough, fever, and retroorbital pain suggest a systemic viral illness (dengue, influenza, enteroviruses). Viral myocarditis classically presents with nonspecific ST-T changes on ECG.
- Dengue fever — the clinical triad of fever + retroorbital pain + headache + dry cough/vomiting is classic dengue. Dengue can cause myocarditis with T-wave changes, sinus bradycardia/tachycardia, and rarely conduction abnormalities.
Clinical Correlation
The symptom complex — fever ×3 days, dry cough, 2 episodes of vomiting, retroorbital pain, and headache — in a 24-year-old male is highly consistent with dengue fever or another arboviral/systemic viral illness.
Priority workup:
| Test | Rationale |
|---|---|
| CBC with differential | Look for leukopenia + thrombocytopenia (dengue hallmark) |
| NS1 antigen + dengue IgM/IgG | Confirm dengue |
| Serum electrolytes (K⁺, Mg²⁺) | Explain T-wave changes from vomiting |
| Cardiac troponin (hs-TnI/T) | Exclude myocarditis if T-wave changes persist |
| LFTs | Dengue hepatitis is common |
| Hematocrit | Assess for plasma leakage (dengue warning signs) |
ECG management:
- This ECG does not show ischemia, AV block, prolonged QTc, or dangerous arrhythmia.
- Nonspecific T-wave changes in the setting of fever/vomiting are expected and usually resolve with defervescence and electrolyte correction.
- Repeat ECG if troponin is elevated or clinical deterioration occurs.
Bottom Line
Sinus rhythm at 93 bpm with nonspecific T-wave changes — most consistent with fever-related repolarization changes ± electrolyte disturbance from vomiting, in the context of a likely dengue fever presentation. No acute ischemia, no dangerous arrhythmia, no QT prolongation. Manage the underlying illness and recheck electrolytes.
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