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ECG Interpretation
Patient: Mrs. Gomati, 63 years old, Female, Non-smoker
Facility: Apex Hospital, Jaipur
Date: 27-May-2026
Settings: Speed 25 mm/s | Gain 1.00 cm/mV | HF 0.05 Hz | LF 35 Hz | Notch 50 Hz
Systematic Analysis
Rate: 81 bpm (normal)
Rhythm: Regular sinus rhythm - P waves are present and precede each QRS
Axis: The machine notes approximately -30°, which is in the left axis deviation range (borderline/mild LAD)
Intervals (from machine printout):
- PR interval: ~172 ms (upper limit of normal; borderline first-degree AV block)
- QRS: ~96 ms (normal, <120 ms)
- QT/QTc: ~431/~500 ms - QTc is prolonged (>440 ms in females)
Lead-by-Lead Analysis
Limb Leads:
| Lead | Finding |
|---|---|
| I | Upright QRS, positive deflection |
| II | Positive QRS, visible P waves |
| III | Small/isoelectric complex |
| aVR | Negative QRS (expected) |
| aVL | Positive QRS |
| aVF | Low-amplitude or biphasic |
Precordial Leads:
| Lead | Finding |
|---|---|
| V1 | Small r wave, deep S - RSR' pattern not clearly seen |
| V2 | rS morphology |
| V3 | Transition zone |
| V4 | Dominant R wave developing |
| V5 | Tall R wave |
| V6 | Upright R wave |
Key Abnormalities Identified:
-
ST-segment changes: There appear to be ST-T wave abnormalities visible in the precordial leads (V4-V6), with flattening or mild depression - suggesting lateral ischemia or strain pattern.
-
T-wave changes: Flattened or inverted T waves in the lateral leads (V5-V6, I, aVL) - consistent with lateral ischemic changes or LVH strain.
-
Left axis deviation (machine-reported at ~-30°): Could represent left anterior fascicular block (LAFB) or inferior infarction.
-
Prolonged QTc (~500 ms): Significantly prolonged - this is clinically important. Can be drug-induced, electrolyte disturbance (hypokalemia, hypomagnesemia, hypocalcemia), or intrinsic cardiac disease.
-
Possible LVH criteria: Tall R waves in lateral leads with associated ST-T changes may suggest left ventricular hypertrophy.
Summary / Impression
Sinus rhythm at 81 bpm with:
- Left axis deviation (borderline LAFB)
- Prolonged QTc (~500 ms) - clinically significant, requires urgent evaluation
- ST-T wave abnormalities in lateral leads - possible lateral ischemia or LVH strain pattern
- Borderline prolonged PR (possible 1st degree AV block)
Clinical Recommendations
Given this is a 63-year-old woman presenting to hospital:
- Prolonged QTc (~500 ms) is the most urgent finding - check electrolytes (K+, Mg2+, Ca2+), review all medications for QT-prolonging drugs (antipsychotics, antibiotics, antiemetics, antiarrhythmics)
- Lateral ST-T changes - correlate with symptoms (chest pain, dyspnea, syncope). Obtain serial ECGs and cardiac troponins to rule out ACS
- Echo recommended to assess LV function and wall motion abnormalities
- Consider cardiology consultation given the combination of QTc prolongation and ischemic-appearing ST-T changes
Disclaimer: This is an AI-assisted interpretation for educational support only. All ECG findings must be reviewed and confirmed by a qualified physician or cardiologist before any clinical decisions are made.
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