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Reading File
I now have a thorough view of the ECG. Let me provide the full systematic analysis.
ECG Analysis
⚠️ Disclaimer: This is an AI-assisted interpretation for educational/clinical support purposes only. Formal diagnosis must be confirmed by a qualified clinician. The image quality and angle limit precision measurements.
Systematic Read
Rate & Rhythm
- Rate appears approximately 75–90 bpm (regular R-R intervals visible in rhythm strip)
- Rhythm is regular sinus rhythm — P waves precede each QRS with consistent morphology
Axis
- Limb leads (I, II, III, aVL, aVF): Dominant positive QRS in lead I and aVF → Normal axis (approximately 0° to +90°)
P Waves
- Present and upright in leads I and II
- Morphology appears normal; no obvious bifid or biphasic pattern to suggest atrial enlargement definitively at this resolution
PR Interval
- Appears within normal limits (~3–5 small squares, ~120–200 ms)
QRS Complex
- Tall R waves in V5–V6 and deep S waves in V1–V2
- The tallest QRS amplitude across precordials appears significantly elevated
- This pattern fulfills Sokolow-Lyon voltage criteria for LVH: SV1 + RV5 (or RV6) > 35 mm
ST Segments & T Waves
- Lateral leads (V5, V6, I, aVL): ST segment depression with asymmetric T-wave inversion
- This is the classic "LV strain pattern" — ST depression with downsloping T-wave inversion in leads with dominant R waves
QT Interval
- Appears normal for rate
Primary Diagnosis
Left Ventricular Hypertrophy (LVH) with Strain Pattern
| Feature | Finding |
|---|---|
| Sokolow-Lyon voltage | SV1 + RV5/V6 > 35 mm (met) |
| ST-T changes | Lateral ST depression + T inversion (strain) |
| Axis | Normal |
| Rhythm | Normal sinus rhythm |
Clinical Interpretation
The LVH voltage criteria with strain pattern is the hallmark of pressure-overloaded left ventricle, seen most commonly in:
- Systemic hypertension (most common cause)
- Aortic stenosis
- Hypertrophic cardiomyopathy (HCM)
The ST-T "strain" pattern in lateral leads indicates repolarization abnormality from chronically hypertrophied myocardium and is associated with increased cardiovascular risk beyond voltage alone.
"Multiple voltage criteria for left ventricular hypertrophy have been proposed based on tall left precordial R waves and deep right precordial S waves (SV₁ + RV₅ or RV₆ > 35 mm). Repolarization abnormalities (ST depression with T-wave inversions, formerly called the LV 'strain' pattern) may appear in leads with prominent R waves." — Harrison's Principles of Internal Medicine, 22E
No Evidence Of
- Acute ST-elevation MI (STEMI)
- Bundle branch block (QRS appears narrow)
- Atrial fibrillation
- Significant conduction delay
Suggested Next Steps
- Correlate with blood pressure (hypertension workup)
- Echocardiogram to confirm LVH, assess wall thickness, systolic/diastolic function
- Consider aortic valve evaluation if murmur present
- If HCM suspected: echo with outflow tract assessment
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