Orris
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Interpretation

Reading File
Here is the full interpretation of this ECG:

ECG Interpretation

Machine Parameters (from the printout)

  • QRS: 92 ms
  • QT: 340 ms
  • QTc: 472 ms (borderline prolonged — upper normal is ~440 ms in men, ~460 ms in women)
  • ST: 75
  • Rate: ~75 bpm (estimated from rhythm)
  • Paper speed: 25 mm/s | Gain: 10 mm/mV

Systematic Analysis

1. Rate ~75 bpm — normal rate.
2. Rhythm Regular. Sinus rhythm (P waves visible before each QRS in lead II).
3. Axis P-waves and QRS morphology in limb leads suggest normal axis.
4. P Waves Present and upright in lead II — sinus origin.
5. PR Interval Appears normal (~160–200 ms).
6. QRS Duration 92 ms — borderline/normal upper limit, but the machine flags "intraventricular conduction delay" (visible handwritten note and machine interpretation).
7. QT/QTc
  • QT = 340 ms
  • QTc = 472 ms — this is prolonged (>460 ms in females, >440 ms in males). Clinically significant.
8. ST Segments / T Waves
  • Diffuse ST changes are noted (ST value = 75 on the printout).
  • T-wave morphology should be assessed for flattening, inversion, or peaking across leads.

Machine Interpretation (printed on ECG)

"Intraventricular conduction delay" — confirmed on the tracing.

Key Findings Summary

ParameterFindingSignificance
Rate~75 bpmNormal
RhythmRegular sinusNormal
QRS92 msBorderline — intraventricular conduction delay
QTc472 msProlonged
ST75Possible ST abnormality

Clinical Correlation

  1. Prolonged QTc (472 ms) — increased risk of torsades de pointes. Evaluate for:
    • Electrolyte abnormalities (hypokalemia, hypomagnesemia, hypocalcemia)
    • QT-prolonging medications (the handwritten note mentions "Shingoor 18 mg/day" — verify if this is a QT-prolonging agent)
    • Congenital long QT syndrome
    • Cardiac ischemia
  2. Intraventricular conduction delay — QRS is 92 ms; not a full bundle branch block (which requires ≥120 ms), but suggests slowed conduction, possibly:
    • Early/incomplete right or left bundle branch block
    • Non-specific intraventricular conduction delay (NICD)
  3. The printout notes: "Unconfirmed report — kindly correlate clinically" — standard caveat for automated ECG readings.
Bottom line: Sinus rhythm at ~75 bpm, intraventricular conduction delay, and a prolonged QTc of 472 ms requiring clinical correlation and review of medications/electrolytes.
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Interpretation with condition

This is the same patient's ECG — now with a clearer machine interpretation visible at the top right:
"RBBB WITH MI" / "Intraventricular Conduction Defect with MI"
Let me give a full structured interpretation:

ECG Interpretation

Machine Parameters

ParameterValue
Heart Rate68 bpm
PR314 ms (prolonged — 1st degree AV block)
QRS49 ms (likely a misread — visually appears wider)
QT340 ms
QTc472 ms (prolonged)
ST75

Systematic Analysis

1. Rate

68 bpm — normal sinus rate.

2. Rhythm

Regular. Sinus rhythm with P waves preceding each QRS.

3. PR Interval — 314 ms

Significantly prolonged (normal < 200 ms). → First-degree AV block confirmed.

4. QRS Morphology — RBBB Pattern

The machine flags RBBB with MI. Visually on the tracing:
  • V1–V2: RSR' ("M-shaped" / rabbit-ear) pattern — classic RBBB
  • V5–V6 / I / aVL: Wide, slurred S waves
  • QRS duration appears ≥120 ms visually (machine QRS value of 49 ms is likely a measurement artifact/error)
→ Right Bundle Branch Block (RBBB)

5. Myocardial Infarction (MI) Pattern

The machine specifically calls "RBBB with MI." In the context of RBBB, MI patterns to look for:
Lead GroupFindingTerritory
V1–V4ST elevation or Q wavesAnterior (LAD)
II, III, aVFQ waves / ST changesInferior (RCA)
I, aVLQ waves / ST changesLateral
From the tracing:
  • Deep Q waves / ST changes appear present in the precordial leads consistent with anterior MI (LAD territory)
  • The combination of RBBB + anterior Q waves / ST changes strongly suggests proximal LAD occlusion

6. QTc = 472 ms

Prolonged QTc — risk of ventricular arrhythmias. Contributing factors:
  • Ischemia/MI itself prolongs QT
  • Review medications (BSZ 18 mg/day noted — verify QT profile)

7. First-Degree AV Block (PR = 314 ms)

Markedly prolonged PR. Could reflect:
  • AV nodal ischemia (RCA involvement)
  • Drug effect (beta-blockers, calcium channel blockers, digoxin)
  • Degenerative conduction disease

Summary of Findings

FindingDetail
RhythmSinus rhythm, 68 bpm
Conduction1st degree AV block (PR 314 ms)
Bundle BranchRight Bundle Branch Block (RBBB)
Ischemia/InfarctionMI pattern — likely anterior (LAD territory)
QTcProlonged at 472 ms

Clinical Significance

This ECG pattern of RBBB + MI is a high-risk combination:
  1. New RBBB with anterior ST changes = possible proximal LAD occlusion — a STEMI equivalent requiring urgent intervention
  2. PR prolongation (314 ms) adds concern for multivessel disease or progressive conduction system involvement
  3. Prolonged QTc increases arrhythmia risk in the setting of acute ischemia

Urgent Actions:

  • Compare with prior ECG (new vs. old RBBB is critical — new RBBB in the setting of chest pain = catheterization lab activation)
  • Troponin / cardiac biomarkers stat
  • Cardiology consult immediately
  • Continuous cardiac monitoring
  • Assess for symptoms: chest pain, dyspnea, syncope
⚠️ If this RBBB is new and the patient has chest pain — this is a STEMI equivalent. Do not delay reperfusion.
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