IMG-20260630-WA0000(1).jpg
Interpret this ecg
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ECG Interpretation
Patient: Nagendra Purarduse | Date: 28/06/2026 | Setting: MICU
Machine Measurements
| Parameter | Value |
|---|---|
| Ventricular Rate | 98 bpm |
| PR Interval | 96 ms |
| QRS Duration | 100 ms |
| QT / QTc | 368 ms / 477 ms |
| P / QRS Axis | 73° / 80° |
| RV5/SV1 Amplitude | 0.51 / 0.45 mV |
Systematic Interpretation
Rate: ~98 bpm - borderline sinus tachycardia.
Rhythm: Regular. P waves are upright in II, III, aVF and inverted in aVR - confirms normal sinus rhythm.
PR Interval: Short at 96 ms (normal 120-200 ms). This is a notable finding. Causes of a short PR include:
- Pre-excitation syndrome (WPW) - look for delta waves
- Lown-Ganong-Levine (LGL) syndrome
- AV nodal junctional rhythm (though P morphology here suggests sinus)
- In a MICU patient, also consider artifact, but the machine measurement is consistent
QRS Duration: 100 ms - upper limit of normal. No frank bundle branch block pattern.
QTc: 477 ms - PROLONGED (normal <450 ms in men, <460 ms in women). This is clinically significant, especially in a MICU patient. Common causes to consider:
- Electrolyte disturbances (hypokalemia, hypomagnesemia, hypocalcemia) - very common in ICU
- Drugs (amiodarone, sotalol, antipsychotics, antibiotics like azithromycin, antifungals)
- Cardiac disease (myocarditis, cardiomyopathy)
- Metabolic (hypothyroidism, hepatic failure)
Axis: Normal (P axis 73°, QRS axis 80°).
ST Segments: No significant elevation or depression. ST levels are within ±0.04 mV across all leads - no evidence of acute ischemia or STEMI.
T Waves: No hyperacute or inverted T waves noted.
Voltage: Low voltage QRS in limb leads - consider pericardial effusion, obesity, COPD, hypothyroidism, or infiltrative cardiomyopathy.
Summary / Key Findings
- Sinus tachycardia (~98 bpm)
- Short PR interval (96 ms) - needs correlation with clinical picture; rule out pre-excitation (delta wave)
- Prolonged QTc (477 ms) - investigate and correct reversible causes urgently in this MICU patient; risk of Torsades de Pointes
- Low voltage limb leads - work up as above
- No acute ischemic changes
Clinical note: This ECG was captured in a MICU. The short PR + borderline QRS duration warrants a closer look at each lead for delta waves (slurred QRS upstroke) to exclude WPW. The prolonged QTc requires urgent review of current medications and electrolytes. This interpretation is for clinical reference - always correlate with the patient's full clinical picture.
IMG-20260623-WA0002.jpg
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ECG Interpretation
Patient: Yevale Rangubai | Date: 31/05/2025 | ID: 000002409
Machine Measurements
| Parameter | Value |
|---|---|
| Ventricular Rate | 57 bpm (bradycardia) |
| PR Interval | 128 ms (normal) |
| QRS Duration | 158 ms (markedly wide) |
| QT / QTc | 496 ms / 486 ms (prolonged) |
| P / QRS Axis | -5° / -21° (left axis deviation) |
| RV5/SV1 Amplitude | 2.34 / 0.61 mV |
Primary Diagnosis: Complete Left Bundle Branch Block (LBBB)
The morphology is classic and diagnostic:
- V1-V2: Deep wide S-waves / QS pattern (no initial R)
- V5-V6, I, aVL: Broad, notched (M-shaped) monophasic R-waves
- QRS duration: 158 ms (>120 ms confirms complete LBBB)
- Left axis deviation: QRS axis -21°
Rhythm & Rate
- Sinus bradycardia at 57 bpm
- P waves upright in II, III, aVF; inverted in aVR - confirms sinus origin
- PR interval 128 ms - normal conduction to the AV node
ST-T Changes
The ST/T changes present are appropriate discordance secondary to LBBB - this is expected and does not by itself indicate ischemia:
- V1-V3: ST elevation with upright T waves (opposite to negative QRS) - secondary change
- I, aVL, V5, V6: ST depression and T inversion (opposite to positive QRS) - secondary change
ST Level of note: V3 shows +0.31 mV (3.1 mm) of ST elevation. This is significant. In the context of LBBB, the Sgarbossa Criteria must be applied to detect superimposed ischemia:
| Sgarbossa Criterion | Present? |
|---|---|
| Concordant ST elevation ≥1 mm in leads with positive QRS | Not seen |
| Concordant ST depression ≥1 mm in V1-V3 | Not seen |
| Excessively discordant ST elevation >5 mm (V3 here ~3 mm) | Borderline - does not meet >5 mm threshold |
The ST elevation in V3 is discordant (QS in V3, ST goes up - appropriate direction) and at 3 mm does not meet the modified Sgarbossa >25% ratio criterion definitively. However, this must be correlated with clinical symptoms, troponins, and prior ECGs.
QTc Prolongation
QTc of 486 ms is significantly prolonged even accounting for the wide QRS. In LBBB, the QTc is inherently prolonged due to wide QRS; a corrected QTc (subtracting the "extra" QRS time) should ideally be recalculated. Still warrants review of electrolytes and medications.
Summary of Key Findings
- Complete LBBB - the dominant finding (QRS 158 ms, classic morphology)
- Sinus bradycardia (57 bpm)
- Left axis deviation (-21°)
- Secondary ST-T changes consistent with LBBB - no definitive Sgarbossa-positive ischemia, but V3 ST elevation at 3 mm warrants clinical correlation
- Prolonged QTc (486 ms)
Clinical priority: New LBBB in a symptomatic patient is a STEMI-equivalent until proven otherwise per current guidelines. If this is a new or presumed new LBBB, urgent clinical assessment, troponin measurement, and cardiology review are mandatory. Compare with any prior ECG. If LBBB is known and chronic, this likely represents the baseline.
IMG-20260623-WA0016.jpg
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ECG Interpretation
Patient: Jadhav Prabhakar | Age/Sex: 71Y Male | Date: 09/05/2025
Machine Measurements
| Parameter | Value |
|---|---|
| Ventricular Rate | 47 bpm (severe bradycardia) |
| PR Interval | 316 ms (markedly prolonged) |
| QRS Duration | 100 ms (normal) |
| QT / QTc | 514 ms / 463 ms |
| P / QRS / T Axis | 90° / 53° / 69° |
| RV5/SV1 | 1.90 / 0.17 mV |
ST Levels: All leads essentially isoelectric (V3: +0.06 mV - within normal limits)
Systematic Interpretation
Rhythm & Rate
- Sinus bradycardia at 47 bpm
- P waves upright in II, III, aVF; inverted in aVR - normal sinus origin
- P axis 90° - normal
PR Interval - KEY FINDING
PR = 316 ms - this is a First-Degree AV Block (>200 ms). At 316 ms, this is markedly prolonged. In a 71-year-old, causes include:
- Age-related fibrosis of the conduction system (most common)
- Medications: beta-blockers, calcium channel blockers, digoxin, amiodarone
- Inferior MI (affects AV nodal blood supply - RCA territory)
- Hypothyroidism, electrolyte disturbances
- Myocarditis, cardiac sarcoidosis, Lyme disease
A PR of 316 ms combined with a rate of 47 bpm should prompt evaluation for higher-degree AV block or sick sinus syndrome. A 24-hour Holter monitor is advisable to exclude intermittent 2:1 or Wenckebach block.
QRS Morphology
- Duration 100 ms - normal, no bundle branch block
- QRS axis 53° - normal
- Normal R-wave progression V1-V6
- No pathological Q waves - no evidence of prior infarction
- No delta waves, no LBBB/RBBB
ST Segments & T Waves
- All ST levels isoelectric - no ischemic changes
- V3 has +0.06 mV - well within normal limits, likely early repolarization variant
- T waves upright and normal in lateral and inferior leads
- No hyperacute T waves, no T inversion in ischemic territory
QTc
- QTc 463 ms - borderline prolonged (>450 ms in males). The slow rate falsely inflates the absolute QT (514 ms), but even the corrected value is mildly elevated. Review medications and electrolytes (K+, Mg2+, Ca2+).
Hypertrophy
- No LVH or RVH criteria met
Summary of Key Findings
- Sinus bradycardia - 47 bpm (significant - requires clinical correlation)
- First-Degree AV Block - PR 316 ms (markedly prolonged - dominant abnormality)
- Borderline QTc prolongation - 463 ms
- No acute ischemia, no infarction, no bundle branch block
Clinical note for this 71-year-old: The combination of severe sinus bradycardia + markedly prolonged PR (316 ms) suggests diffuse conduction system disease. Immediate review of all AV-nodal slowing drugs is recommended. If symptomatic (dizziness, pre-syncope, syncope, fatigue), this warrants urgent cardiology referral and Holter monitoring to exclude higher-degree AV block that may require pacemaker implantation.
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