Interpret this ecg
Reading File
Finding Sources
Loading Image
I can now clearly see the ECG. Let me provide a thorough interpretation.
ECG Interpretation
The tracing is a standard 12-lead ECG recorded at 25 mm/s, 10 mm/mV (standard settings visible on the label). The paper is rotated 90°, but all 12 leads are identifiable.
Rate & Rhythm
- Heart rate: ~52–58 bpm (bradycardic range based on R-R interval spacing)
- Rhythm: Sinus bradycardia — P waves are present, upright in lead I and II, each followed by a QRS. The rhythm appears regular.
Intervals
| Parameter | Estimate |
|---|---|
| PR interval | ~160–180 ms — normal |
| QRS duration | ~80–100 ms — narrow (normal) |
| QTc | Appears prolonged — requires precise measurement, but QT looks visually long relative to the R-R interval |
Axis
- Lead I: positive QRS
- aVF: positive QRS
- → Normal axis (~0° to +60°)
P Waves
- Present and upright in I, II, aVF — consistent with sinus origin
- Normal morphology
QRS Complexes
- Narrow — no bundle branch block pattern
- No significant delta waves (no pre-excitation)
- Low voltage may be present in limb leads (QRS amplitude <5 mm in limb leads) — worth noting
ST Segments & T Waves — Key Findings
This is the most notable area:
- V1–V3: There is ST elevation with a "saddleback" or coved morphology visible in the anterior leads (V1–V3). The ST segments appear elevated with terminal T-wave inversion, particularly in V1–V2.
- V4–V6: ST segments appear relatively flat or minimally depressed.
- Inferior leads (II, III, aVF): ST segments appear at baseline or mildly depressed.
- aVR: Appears to show ST elevation (reciprocal pattern).
⚠️ The ST changes in V1–V3 — elevated with coved/saddleback morphology and T-wave inversion — raise concern for a Brugada pattern (Type 1 or Type 2), or alternatively anterior STEMI / LAD territory ischemia.
The morphology in V1–V2 (if truly coved with ≥2 mm ST elevation and negative T wave) would meet criteria for a Type 1 Brugada pattern.
Impression
| Finding | Interpretation |
|---|---|
| Rate ~52–58 bpm, regular sinus P waves | Sinus bradycardia |
| Narrow QRS, normal axis | No BBB, no accessory pathway |
| ST elevation V1–V3 with T-wave inversion | Possible Brugada pattern (Type 1) or anterior ischemia |
| No obvious reciprocal ST depression in inferior/lateral leads | Less consistent with acute STEMI alone |
Clinical Recommendations
- Correlate clinically — symptoms (syncope, palpitations, family history of sudden cardiac death) strongly support Brugada evaluation.
- If Brugada suspected: Repeat ECG in V1–V2 placed at the 2nd/3rd intercostal space; consider sodium channel blocker provocation test (ajmaline/flecainide) under monitored conditions.
- If ischemia cannot be excluded: Serial ECGs + troponins + urgent cardiology review.
- The sinus bradycardia may be physiological (athlete, vagal tone) or drug-related — check medications (beta-blockers, calcium channel blockers, digoxin).
- Avoid drugs that can precipitate Brugada arrhythmias (sodium channel blockers, tricyclics, certain antiarrhythmics) until Brugada is excluded.
⚠️ Disclaimer: This is a remote, image-based interpretation. The image quality and rotation limit precision. A formal interpretation by a cardiologist with the original tracing is mandatory before any clinical decision.
This is a shared conversation. Sign in to Orris to start your own chat.