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What is the pathology’s in this ecg

Reading File
analyse_media
Running Command

cd /tmp/workspace/attachments/3bc12293-3b47-471a-b3d1-eaa923f5b596/ && python3 -c " from PIL import Image im=Image.open('IMG_1501.jpg'); print(im.size) im.rotate(-90,expand=True).save('/tmp/workspace/ecg_rot.jpg') "

Reading File
Finding Sources
Running Command

cd /tmp/workspace/attachments/3bc12293-3b47-471a-b3d1-eaa923f5b596/ && python3 -c " from PIL import Image im=Image.open('IMG_1501.jpg') im.rotate(90,expand=True).save('/tmp/workspace/ecg_rot.jpg') "

Reading File
Finding Sources
Main finding: left ventricular hypertrophy (LVH) with a lateral "strain" repolarization pattern (ST depression and T-wave abnormality in V4-V6).
I rotated the photo to read it. Image quality is limited, so treat these as my read of the tracing.
What I see
  • Rhythm: Regular sinus rhythm, with a P wave before each narrow QRS. The rate is roughly 70-80 bpm and I see no AV block.
  • QRS width: Narrow, so there is no bundle branch block.
  • Axis: Normal to slightly leftward. Lead I and lead II are upright, and lead III is small and biphasic.
  • V1-V3: Very deep S waves (rS), reaching the very large amplitude of V3.
  • V4-V6: Very tall R waves. The ST segments are depressed, downsloping or sagging, with flat or inverted T waves.
  • Voltage: The S wave in V2-V3 plus the R wave in V5-V6 clearly exceeds the Sokolow-Lyon threshold of 35 mm. That fits LVH.
  • Limb leads and aVR: There is no obvious ST elevation. The ST changes are in the lateral chest leads.
Interpretation
  1. LVH by voltage criteria.
  2. ST depression with T-wave changes in V4-V6, which is the classic LVH strain pattern.
Clinical context The page header reads "...tional Angina", and the Russian text says a 66-year-old man was admitted to the coronary care unit. In that setting the same lateral ST depression could also be subendocardial ischemia from angina. The two can coexist. An ECG alone can't separate them, and the history decides. Look for:
  • Chest pain with exertion that eases at rest.
  • Hypertension or aortic stenosis as a cause of LVH.
  • Dynamic ST changes between pain and pain-free tracings.
  • Troponin results.
I can't tell which of these your question is after. If the answer options are on the page, send them and I'll pick the best fit.
I didn't find a matching textbook passage in the library, so this comes from my own ECG interpretation rather than a cited source.

I see inferior wall mi and 3rd degree av block also can you please confirm

Running Command

cd /tmp/workspace && python3 -c " from PIL import Image im=Image.open('ecg_rot.jpg') r=im.crop((0,780,1600,920)); r=r.resize((r.width*2,r.height*3)); r.save('strip.jpg') l=im.crop((0,230,800,730)); l=l.resize((l.width*2,l.height*2)); l.save('limb.jpg') "

Reading File
Reading File
I can't confirm 3rd degree AV block, and I need to correct my first read, where I said there was no AV block. After zooming into the rhythm strip, I think this is 2nd degree AV block, Mobitz I (Wenckebach). The inferior MI is possible but not certain.
Why not complete (3rd degree) AV block
  • In complete heart block, the atria and ventricles are fully dissociated. The ventricular rate is slow and regular (usually 30-45 bpm), and the PR interval varies randomly.
  • This strip is different. The P waves march out regularly at about 65-70 bpm, and the ventricular rate is similar, about 65 bpm. Most P waves are followed by a narrow QRS.
  • The PR interval changes in a pattern, not randomly. It lengthens over the first few beats of a group, one P wave is then not followed by a QRS, and the cycle repeats.
  • The pause is shorter than two P-P intervals. That fits Wenckebach and argues against complete block.
I measured on a photo of a printout, so the exact PR values are approximate. To be sure, put calipers on the P-P interval and check that the dropped-beat pause is less than twice that interval. A longer strip would also help.
Inferior MI
  • In leads III and aVF I see a small q wave with notching and low R-wave amplitude, and the T waves are flat.
  • I don't see convincing ST elevation in II, III or aVF. So this would look like an evolving or old inferior infarct, not an acute STEMI.
  • Inferior MI plus Wenckebach is a classic pairing. The RCA supplies the AV node, so the block is usually transient and nodal.
What I'd still keep from my first read
  • There are very tall voltages (deep S in V2-V3, tall R in V5-V6).
  • There is lateral ST depression with T-wave changes in V4-V6. This could be LVH strain, ischemia or both.
Suggested answer Sinus rhythm with 2nd degree AV block Mobitz I, inferior Q-wave changes (consistent with inferior MI), and LVH with lateral repolarization changes.
The page header mentions angina and the setting is a coronary care unit. If your question has answer options, send them and I'll match the best fit. If the stem says "complete AV block", I'd want to see ventricular escape beats and clearly independent P waves on the strip, and I don't see either here.
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