IMG-20260709-WA0034.jpg
Is any thing here
analyse_media
Yes - there is quite a bit here. This is a 12-lead ECG for a 23-year-old female named Megha, dated 2026-07-30. Here is a full breakdown:
Patient Details
- Name: Megha | Sex: Female | Age: 23
- Paper speed: 25 mm/s | Sensitivity: 10 mm/mV
Measured Intervals (from the machine printout)
| Parameter | Value | Normal Range |
|---|---|---|
| Heart Rate | 68 bpm | 60-100 bpm |
| PR Interval | 126 ms | 120-200 ms |
| QRS Duration | 93 ms | <120 ms |
| QT / QTc | 386 ms / 411 ms | QTc <460 ms (females) |
| QRS Axis | 128.8° | -30° to +90° |
Key Findings
1. Rhythm - Normal Sinus Rhythm
Upright P waves before every QRS in leads I, II, aVF; inverted in aVR. Regular R-R intervals. Rate 68 bpm.
2. Right Axis Deviation (RAD)
The QRS axis is ~128.8°. Lead I shows a deep S wave (predominantly negative QRS), while leads II, III, and aVF show prominent R waves. This confirms RAD.
3. QS/rS pattern in aVL
Lead aVL shows a QS or rS pattern with a flattened/slightly inverted T wave. This, combined with the deep S in lead I, is what prompted the machine's "old high lateral MI" flag.
4. ST Segments - Generally isoelectric; no acute ST elevation or depression across precordial or limb leads.
5. T waves - Upright and normal in V2-V6.
Machine's Automated Conclusions (printed on ECG)
The machine flagged:
- Middling Right axis deviation
- Old high lateral MI (myocardial infarction)
- **Report needs physician confirmation**
Important Clinical Note
The "old high lateral MI" flag from the machine is very likely a false positive in this context. The QS pattern in aVL and deep S in lead I that triggered this interpretation are the same morphology causing the RAD - in a 23-year-old female, an actual prior myocardial infarction is extremely unlikely.
Possible real causes of RAD in a young woman include:
- Normal variant (especially in thin/tall individuals)
- Right ventricular hypertrophy (e.g., from pulmonary hypertension, congenital heart disease)
- Left posterior fascicular block
- Lateral wall MI - statistically very unlikely at age 23 without risk factors
This ECG must be reviewed by a physician alongside the patient's symptoms, history, and physical exam before any conclusions are drawn. The machine's "old MI" interpretation should not be taken at face value without clinical correlation.
Is avr should be negative?
Yes, aVR is normally negative - and that is exactly what you see on this ECG, which is correct and expected.
Why aVR is Normally Negative
aVR (augmented Vector Right) looks at the heart from the right shoulder, which is the opposite direction to the main electrical flow of the heart.
The heart's main depolarization travels downward and to the left (toward the apex), which is away from the aVR electrode. Because the electrical activity is moving away from it:
- P wave - negative (or biphasic) in aVR
- QRS complex - predominantly negative (deep QS or rS pattern)
- T wave - usually negative in aVR
Quick Rule to Remember
| Lead | Normal QRS direction |
|---|---|
| Lead I | Positive (leftward) |
| Lead II | Positive (downward-left) |
| aVF | Positive (downward) |
| aVR | Negative (away from left-down axis) |
On This ECG Specifically
In Megha's ECG, aVR shows:
- Inverted P wave - normal
- Predominantly negative/QS QRS - normal
- Inverted T wave - normal
This is one of the reassuring findings on this tracing. If aVR were positive (upright QRS), that would actually be a red flag - it can indicate things like:
- Severe global ischemia or LMCA (left main coronary artery) occlusion (ST elevation in aVR with diffuse ST depression elsewhere)
- Sodium channel toxicity (tricyclic antidepressant overdose, etc.)
- Lead misplacement
So the negative aVR on this ECG is completely normal and expected.
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