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ECG left ventricular hypertrophy ST depression T wave changes

Now let me carefully analyze the ECG image provided. Here is a comprehensive interpretation:

ECG Interpretation

Technical details (from the tracing header):
  • Date: 22-04-2026, Time: 10:23:22
  • Speed: 25 mm/s | Gain: 10 mm/mV
  • Heart rate: 79 bpm (shown at bottom: ♥79)
  • Filter: 0.25–100 Hz, PT50

1. Rhythm

  • Sinus rhythm — regular P waves precede each QRS complex
  • Rate: ~79 bpm (within normal limits)
  • PR interval: appears normal (~160–180 ms)

2. P Waves

  • Upright in I, II, aVF — confirming sinus origin
  • Morphology appears normal

3. QRS Complex

  • Axis: Normal to left axis
  • Duration: Appears within normal range (~80–100 ms), no bundle branch block
  • Voltage: High-amplitude QRS complexes are present
    • Deep S waves in V1–V2
    • Tall R waves in V4–V6
    • This meets Sokolow-Lyon criteria for Left Ventricular Hypertrophy (LVH): S(V1) + R(V5 or V6) ≥ 35 mm

4. ST Segment & T Waves

  • ST depression with T-wave inversion/flattening in lateral leads (I, aVL, V5, V6) and inferolateral leads (II, III, aVF)
  • These repolarization changes are characteristic of the LVH "strain pattern"
  • V1–V3: ST segment appears relatively upright/elevated (reciprocal pattern)
  • No discrete hyperacute T waves or convex ST elevation to suggest acute STEMI

5. QT Interval

  • Appears within normal limits for rate (rate-corrected QTc likely normal)

Summary / Interpretation

Sinus rhythm, 79 bpm. Left ventricular hypertrophy (LVH) with secondary repolarization changes (strain pattern).
Key findings:
FindingLeads
High QRS voltage (LVH)V1–V2 deep S; V5–V6 tall R
ST depression + T-wave inversionI, aVL, V5, V6 (lateral strain)
ST/T changes inferiorlyII, III, aVF
No Q waves of infarction—
No bundle branch block—

Clinical Significance

LVH with strain pattern is most commonly seen in:
  1. Hypertensive heart disease (most common cause) — chronic pressure overload
  2. Aortic stenosis or other valvular disease
  3. Hypertrophic cardiomyopathy
Important differentials to consider:
  • The lateral ST depression could represent subendocardial ischemia — in the clinical context of chest pain or known coronary artery disease, this distinction requires correlation with symptoms, troponin, and clinical history
  • If the patient is hypertensive or has known LVH, the strain pattern is the more likely explanation
Recommended clinical correlation:
  • Blood pressure measurement
  • Echocardiography to assess LV wall thickness and mass
  • Troponin if acute ischemia is suspected
  • Prior ECG comparison if available
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