Patient Details

Measured Parameters (Machine-Calculated)

Technical Settings

• Filter: 0.67-25 Hz
• AC filter: 50 Hz
• Speed: 25 mm/s
• Gain: 10 mm/mV
• Leads recorded: I, II, III, aVR, aVL, aVF, V1-V6 (standard 12-lead)

Key Observations from the Tracing

1. Rate: 61 bpm - normal sinus range.
2. PR interval: 192 ms - upper limit of normal (borderline first-degree AV block; >200 ms = definite first-degree block). Worth watching.
3. QRS: 116 ms - mildly prolonged (normal <120 ms), borderline. Suggests possible incomplete bundle branch block or IVCD (intraventricular conduction delay).
4. QTc: 452 ms - mildly prolonged in a male (normal <440 ms in males). This warrants attention, especially if the patient is on QT-prolonging medications.
5. QRS axis: +9° - normal axis.
6. RV5/SV1 voltages appear low-normal; no clear LVH by voltage criteria based on these numbers alone.

Important Notes

• The "Diagnosis Information" and "Report Confirmed by" sections are blank on this printout - no automated diagnosis was printed.
• This is a machine printout only, not a verified clinical report.
• A cardiologist or physician should formally read and interpret this ECG, especially given:
  • Borderline prolonged QTc (452 ms)
  • Borderline PR (192 ms)
  • Mildly broad QRS (116 ms)

ECG Diagnostic Assessment

1. Sinus Rhythm - Normal Rate

• HR 61 bpm with regular P waves - this is normal sinus rhythm.

2. First-Degree AV Block (Borderline)

• PR interval = 192 ms - just below the cutoff of 200 ms.
• Technically not yet first-degree AV block, but borderline and should be monitored.
• As confirmed by Braunwald's Heart Disease: first-degree AV block is defined when PR exceeds 0.20 sec (200 ms) in adults.
• Causes in a 63-year-old male include: ischemic heart disease, fibrosis of the conduction system (Lev's disease), electrolyte imbalance, medications (beta-blockers, calcium channel blockers, digoxin).

3. Intraventricular Conduction Delay (IVCD) / Incomplete Bundle Branch Block

• QRS = 116 ms - normal is <120 ms, so this is borderline widened.
• This is consistent with IVCD or incomplete bundle branch block (RBBB or LBBB pattern).
• Per Fuster and Hurst's The Heart: "Intraventricular conduction disturbances are usually associated with significant structural heart disease, especially dilated (ischemic or idiopathic) cardiomyopathies, and are a marker of poor prognosis in terms of advanced heart failure and increased mortality."
• In a 63-year-old, the most common underlying cause would be ischemic heart disease or hypertensive heart disease.

4. Mildly Prolonged QTc (452 ms)

• Normal QTc in males is <440 ms; borderline prolonged is 440-460 ms; prolonged is >460 ms.
• At 452 ms, this is mildly prolonged in a male.
• Causes to consider:
  • Electrolyte disturbances - hypokalemia, hypomagnesemia, hypocalcemia
  • Medications - antiarrhythmics, antipsychotics, antibiotics (fluoroquinolones, azithromycin), antidepressants
  • Ischemic heart disease
  • Hypothyroidism
  • Risk of Torsades de Pointes (TdP) increases with QTc >500 ms, but even mild prolongation warrants review of medications and electrolytes.

5. Overall Most Likely Diagnoses

Recommended Next Steps

1. Clinical history - chest pain, breathlessness, syncope, palpitations, hypertension, diabetes
2. Medication review - any QT-prolonging drugs?
3. Blood tests - serum K+, Mg2+, Ca2+, TSH, renal function, lipid profile, fasting glucose
4. Echocardiogram - to assess LV function and wall motion abnormalities
5. Stress ECG or coronary workup if symptoms suggest ischemia
6. Formal cardiologist review - especially to characterize the bundle branch pattern on V1-V6

Disclaimer: This is an educational interpretation only. A qualified cardiologist must formally read and report this ECG in the context of the patient's full clinical history.

Is Rajith Kumar Fit for Cataract Surgery Based on This ECG?

Short Answer: YES - he is likely fit for surgery.

Why Cataract Surgery is Special

"Low-stress surgeries with minimal fluid shifts are considered low risk (e.g., cataracts, biopsies) and are associated with a <1% risk of MACE (Major Adverse Cardiac Events)."

• Done under topical/local anesthesia (no general anesthesia in most cases)
• Very short duration (15-30 minutes)
• Minimal blood loss, minimal fluid shifts
• Minimal hemodynamic stress on the heart

ECG Findings vs. Surgical Risk

When Would Surgery Need to Be Postponed?

• Unstable angina or recent MI (<60 days)
• Decompensated heart failure
• Significant arrhythmia (e.g., complete heart block, sustained VT, AF with rapid ventricular rate)
• Severe valvular disease (e.g., severe aortic stenosis)

Practical Recommendations Before Proceeding

1. Check electrolytes (K+, Mg2+) - to explain the mildly prolonged QTc and optimise before surgery.
2. Review medications - stop any QT-prolonging drugs if identified.
3. Anesthesiologist/physician clearance - routine pre-op clearance note is advisable.
4. No need for cardiology referral or further cardiac workup before a cataract surgery in the absence of active cardiac symptoms.

Bottom Line

This ECG does NOT disqualify Rajith Kumar from cataract surgery. The procedure carries <1% cardiac risk by itself. The borderline findings (PR, QRS, QTc) warrant documentation and follow-up but are not reasons to cancel or delay an elective cataract operation. Standard pre-op protocol and anaesthetist clearance are sufficient.