ECG Analysis - 70-Year-Old with History of Angioplasty

Machine-Read Parameters (from report)

My ECG Interpretation

• The axis is more negative than -30°, qualifying as left axis deviation, and at -49° it is "marked."
• The most likely cause in this context is Left Anterior Fascicular Block (LAFB) - also called left anterior hemiblock. Per Harrison's (22E): "Left anterior fascicular block (QRS axis more negative than -45°) is probably the most common cause of marked left axis deviation in adults."
• Other contributors: inferior MI (scar from prior ischemic disease), or LVH.

• QRS duration of 140 ms is prolonged (>120 ms = bundle branch block territory).
• The morphology on the tracing suggests an intraventricular conduction delay - the machine calls it "IV conduction defect" rather than a full LBBB or RBBB pattern. This may represent a non-specific intraventricular conduction delay (NICD) or an incomplete bundle branch block, possibly related to scar tissue from prior LAD territory disease.

• In V1-V2, there is loss of normal septal r-wave / poor R-wave progression, consistent with a prior anteroseptal MI (Q-wave equivalent).
• Given his history of angioplasty (almost certainly for LAD or diagonal territory), this represents old scar from the territory that was stented.
• "Age undetermined" means this finding is chronic - it could be present since the index MI.

• In leads I, aVL, V5-V6: there are ST-T wave changes (flattening or inversion).
• In the context of LAFB + wide QRS, some ST-T changes can be secondary (expected from the conduction abnormality).
• However, the machine flags these as potentially ischemic, and in a 70-year-old post-angioplasty patient, lateral ischemia must be actively considered - particularly if the patient has symptoms.

Clinical Correlation - This Is an Abnormal ECG

What This ECG Does NOT Tell You

• Is there active ACS? The ST-T changes could be new (ischemia) or old (scar/LAFB-related). Comparison with a prior ECG is essential.
• Is the stent patent? In-stent restenosis of the LAD could worsen both the septal pattern and lateral ischemia.
• LV function? The wide QRS + old infarct pattern raises concern for reduced EF - an echo would be informative.

Recommended Next Steps

1. Compare with prior ECG - any new ST-T changes from baseline are more concerning.
2. Troponin - if the patient has any chest discomfort, dyspnea, or atypical symptoms, rule out NSTEMI.
3. Echocardiogram - assess LV function, regional wall motion abnormalities (anteroseptal and lateral walls).
4. Review medications - ensure dual antiplatelet therapy compliance post-angioplasty; check for QT-prolonging agents (QTc 443).
5. Cardiology review - especially if symptoms are present or ECG has changed from baseline.

Disclaimer: This analysis is for educational and clinical decision support purposes. The treating physician must correlate with the patient's symptoms, prior ECGs, and clinical examination before acting on this interpretation. The machine report itself notes this was made "without knowing patient's gender/age" - now that we know this is a 70-year-old male post-angioplasty, the clinical weight of the ischemia flag increases.