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"atrial flutter" AND "ST elevation" AND "anterolateral"

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Here is a detailed explanation of this ECG report.

ECG Report - Full Explanation

Patient & Technical Details

ParameterValue
Date/Time30-05-2026, 14:32:15
MachineCardioTouch (Bionet Co.)
Speed25 mm/sec
Gain10 mm/mV
FiltersBase 0.2 Hz, LPF 150 Hz, AC 50 Hz

Measured Intervals

MeasurementValueNormal Range
Heart Rate187 bpm60-100 bpm
PR/RR Interval124/321 ms120-200 ms (PR)
QRS Duration116 ms<120 ms
QT/QTc208/360 ms<440 ms (QTc)
P-R-T Axes-129 / -28 / -131QRS axis -28 is normal

Computer Analysis Results (Key Findings)

The machine has flagged 3 critical findings, all marked ## (to be finally confirmed by physician):

1. Atrial Flutter

What it is: A rapid, regular atrial arrhythmia caused by a macro-reentrant circuit typically confined to the right atrium, traveling counterclockwise around the tricuspid annulus. The atria fire at ~300 beats/min, with the ventricles typically responding at half that rate (2:1 block = ~150 bpm).
Why the rate is 187 bpm here: At a heart rate of 187 bpm, this is consistent with atrial flutter with a variable or near 2:1 AV conduction ratio. The atrial flutter rate (~300 bpm) divided by 1.6 gives this ventricular rate, suggesting some variable block or a slightly atypical flutter circuit.
What to look for on the tracing:
  • Sawtooth (flutter) waves - negative in leads II, III, and aVF; positive in V1 (typical counterclockwise flutter)
  • No distinct P waves - replaced by continuous flutter waves
  • Regular or regularly-irregular QRS complexes
As described in Goldman-Cecil Medicine: "Typical atrial flutter can be recognized by a 'sawtooth' P wave morphology, which is predominantly negative in leads II, III, and aVF and positive in V1 (counterclockwise atrial flutter)."

2. Normal QRS Axis

  • The P-R-T axis shows QRS axis of -28 degrees - this is at the borderline of normal/mild left axis deviation, but the machine has classified it as normal.
  • Normal axis range is -30 to +90 degrees, so -28 is just within normal limits.

3. ST Abnormality - Possible Transmuural Anterolateral Injury

This is the most clinically urgent finding.
The machine reports: "ST abnormality, possible transmural injury (anterolateral)"
  • SV1/RV5/R+S: 0.00/0.83/0.83 mV
What "transmural anterolateral injury" means:
  • ST elevation in the anterolateral leads (I, aVL, V4-V6) suggests acute full-thickness myocardial injury - the pattern of an ST-elevation MI (STEMI) involving the territory supplied by the left anterior descending (LAD) or left circumflex artery.
  • "Transmural" = injury extending through the full thickness of the myocardial wall.
Important caveat: ST changes during atrial flutter can be secondary (rate-related) rather than primary ischemic. At a heart rate of 187 bpm, demand ischemia and rate-related ST depression/elevation are possible even without coronary artery occlusion. The machine itself flags this as "possible" and requires physician confirmation.

Summary: What This ECG Tells Us

RHYTHM:    Atrial Flutter (~300 atrial / ~187 ventricular bpm)
RATE:      187 bpm — markedly elevated
AXIS:      Normal (-28°)
ST:        Possible anterolateral transmural injury
OVERALL:   MARKEDLY ABNORMAL ECG

Clinical Priority

This is a markedly abnormal ECG (as stated on the report). The combination of:
  1. Rapid atrial flutter with fast ventricular rate (187 bpm)
  2. ST changes suggesting possible anterolateral ischemia/injury
...requires urgent physician review. The two major differential considerations are:
  • Rate-related ST changes - ST abnormalities are common at very high rates and may resolve with rate control (cardioversion or AV nodal blockade)
  • Acute STEMI - If ST elevation persists after rate control, acute coronary syndrome must be ruled out urgently (troponins, repeat ECG, clinical context)
Immediate management steps typically include:
  • Confirm the rhythm clinically (12-lead review by cardiologist)
  • Rate control or cardioversion for atrial flutter
  • Serial troponins and repeat ECG after rate control
  • Echocardiography if wall motion abnormality is suspected
Disclaimer: This analysis is educational. The report itself states "to be finally confirmed by physician." This ECG must be urgently reviewed by the treating clinician - it must not be interpreted in isolation without clinical context.
  • Goldman-Cecil Medicine, p. 573 | Braunwald's Heart Disease, p. 423
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