IMG-20260810-WA0016.jpeg
Interpret this ecg
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Reading File
Here is a full interpretation of this 12-lead ECG:
Patient Details
| Field | Value |
|---|---|
| Name | Niranjana |
| Age | 61 years |
| Sex | Male |
| Date/Time | 10-08-2026, 09:50 PM |
| Facility | D H Mavelikara |
Automated Measurements
| Parameter | Value | Normal Range |
|---|---|---|
| Heart Rate (HR) | 74 bpm | 60-100 bpm ✓ |
| PR interval | 100 ms | 120-200 ms ⚠️ |
| QRS duration | 146 ms | <120 ms ⚠️ |
| QT/QTc | 360/400 ms | QTc <450 ms ✓ |
| P axis | 70° | 0-90° ✓ |
| QRS/T axis | 43/67° | Normal ✓ |
| RV5/SV1 | 1.80/0.857 mV |
Step-by-Step Analysis
1. Rhythm
- Sinus rhythm - Regular P waves are present, each preceding a QRS complex, with normal P-wave axis (70°).
- Rate is 74 bpm - normal.
2. PR Interval - SHORT at 100 ms (Normal: 120-200 ms)
- A PR interval of 100 ms is short. This raises the possibility of:
- Pre-excitation (Wolff-Parkinson-White syndrome) - look for a delta wave (slurred upstroke of the QRS)
- Lown-Ganong-Levine (LGL) syndrome - short PR with normal QRS
- Junctional or accelerated junctional rhythm - though P waves appear upright
3. QRS Duration - WIDE at 146 ms (Normal: <120 ms)
- QRS of 146 ms indicates a significant intraventricular conduction delay. The two most likely patterns are:
- Left Bundle Branch Block (LBBB) - broad, notched R waves in I, aVL, V5-V6; broad S in V1
- Right Bundle Branch Block (RBBB) - RSR' (rabbit ears) pattern in V1-V2; wide S in I, V5-V6
- The combination of short PR + wide QRS strongly suggests WPW or LBBB should be the primary considerations.
4. RV5/SV1 Voltage
- RV5 = 1.80 mV and SV1 = 0.857 mV - together (R in V5 + S in V1 = 2.657 mV). This is borderline for Left Ventricular Hypertrophy (LVH) by Sokolow-Lyon criteria (threshold: >3.5 mV for S-V1 + R-V5/V6). Not meeting strict LVH voltage criteria here, but the QRS morphology should also be assessed.
5. Axes - All Normal
- P axis 70°, QRS axis 43°, T axis 67° - all within normal limits. No axis deviation.
Summary of Key Findings
| Finding | Significance |
|---|---|
| Short PR (100 ms) | Pre-excitation or LGL pattern |
| Wide QRS (146 ms) | Bundle branch block or accessory pathway conduction |
| Normal heart rate (74 bpm) | No tachycardia/bradycardia |
| Normal QTc (400 ms) | No repolarization abnormality |
| Normal axis | No axis deviation |
Primary Interpretation
Most likely diagnosis: Wolff-Parkinson-White (WPW) pattern - the combination of a short PR interval (100 ms) with a wide QRS complex (146 ms) is the classic ECG signature of WPW, where an accessory pathway (Bundle of Kent) causes pre-excitation of the ventricles.
Alternatively: If no delta wave is visible, consider LBBB with a short PR (though this is less common).
Clinical Recommendations
- Assess for delta waves - look for the characteristic slurred initial deflection at the start of the QRS in multiple leads (particularly V3-V5, I, aVL). This is pathognomonic for WPW.
- Cardiology referral is indicated given the wide QRS and short PR - electrophysiology study (EPS) may be needed.
- Avoid AV nodal blocking agents (digoxin, verapamil, adenosine) if WPW is confirmed with tachyarrhythmia, as they can precipitate rapid conduction down the accessory pathway and cause ventricular fibrillation.
- Echocardiogram to assess cardiac structure, particularly if LBBB is the diagnosis (can indicate cardiomyopathy).
- Holter monitoring if the patient has palpitations, syncope, or dizziness.
Disclaimer: This is an AI-assisted ECG interpretation for educational purposes. All ECG findings must be confirmed and clinically correlated by a qualified physician or cardiologist before any clinical decisions are made.
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