Pl interpret
Reading File
Finding Sources
Finding Sources
Reading File
Finding Sources
Finding Sources
Reading File
Here is a full interpretation of this ECG:
ECG Interpretation
Machine Parameters
| Parameter | Value |
|---|---|
| Rate | 99 bpm (borderline tachycardia) |
| P/QRS/T intervals | Documented as 99/60/100 ms |
| RV5/SV1 | 0.519/0.357 mV |
| Speed | 25 mm/s, 10 mm/mV |
Systematic Reading
Rate & Rhythm
- Rate ~99 bpm — upper limit of normal (sinus tachycardia territory)
- Rhythm appears regular sinus rhythm based on consistent P-wave morphology before each QRS
Frontal Axis (Limb Leads)
The machine flags Left Anterior Fascicular Block (LAFB), which means:
- QRS axis more negative than −45° (marked left axis deviation)
- In leads I & aVL: tall R waves
- In leads II, III, aVF: rS pattern (small r, deep S)
- QRS duration is not substantially prolonged (≤120 ms) — confirming this is a fascicular (hemi) block rather than a complete bundle branch block
"Left anterior fascicular block (QRS axis more negative than −45°) is probably the most common cause of marked left axis deviation in adults... partial blocks in the left bundle system generally do not prolong the QRS duration substantially." — Harrison's Principles of Internal Medicine 22E
Voltage
- Low QRS voltage in limb leads (machine-confirmed): QRS amplitude <5 mm in all limb leads
- Differential diagnosis for low voltage:
- Pericardial effusion / cardiac tamponade
- Obesity / emphysema / COPD
- Hypothyroidism
- Infiltrative cardiomyopathy (amyloid, sarcoid)
- Pleural effusion
ST-T Changes (Lateral Leads)
- Machine flags: "Lateral ST-T abnormality may be due to myocardial ischemia"
- ST depression and/or T-wave flattening/inversion in lateral leads (I, aVL, V4–V6)
- This represents subendocardial ischemia of the lateral wall, likely in the territory of the left circumflex artery (LCx)
- Must distinguish primary ST-T changes (ischemia, electrolyte imbalance) from secondary changes due to the LAFB — coexistence is possible and clinically significant
Precordial (Chest) Leads
- V1: small amplitude, flat — consistent with LAFB and low voltage
- V2–V3: transition zone appears delayed (poor R-wave progression)
- V3–V4: relatively tall, narrow QRS complexes with prominent positive deflections
- V4–V6: ST-T changes present
Machine Summary (Confirmed)
- Left Anterior Fascicular Block — conduction disease of the anterior fascicle of the left bundle
- Lateral ST-T abnormality — raise concern for myocardial ischemia (lateral wall NSTEMI or demand ischemia)
- Low QRS voltages in limb leads — warrants investigation for pericardial effusion, infiltrative disease, or COPD/obesity
- Abnormal ECG
Clinical Correlation Recommended
| Finding | Most Likely Cause | Urgent Action |
|---|---|---|
| Lateral ST-T changes | Subendocardial ischemia / NSTEMI | Troponin, repeat ECG, cardiology review |
| Low limb lead voltage | Pericardial effusion / COPD / hypothyroidism | Echo, TFTs, CXR |
| LAFB | Hypertensive/ischemic heart disease, cardiomyopathy | Echo, risk factor assessment |
| Sinus tachycardia (~99 bpm) | Pain, anxiety, hypovolemia, hypoxia, effusion | Treat underlying cause |
The combination of lateral ischemic changes + low voltage + LAFB in the context of sinus tachycardia is concerning and warrants urgent echocardiography (to exclude pericardial effusion/tamponade) and serial troponins (to exclude NSTEMI).
Harrison's Principles of Internal Medicine 22E, pp. 1391–1399
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