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ECG Analysis

Patient: Female, 10 years old | Speed: 25 mm/s | Settings: Base 10, 1PE:40Hz, AC:50Hz, EMG:OFF

Systematic Review

Leads visible: I, II, III, aVR, aVL, aVF (limb leads) + V1, V2, V3, V4, V5, V6 (precordial leads)

Identified Abnormalities

1. Left Ventricular Hypertrophy (LVH)
  • The precordial leads show tall R waves in the left-sided leads (V5/V6) combined with deep S waves in V1/V2
  • The Sokolow-Lyon criteria (S in V1 + R in V5 or V6 > 35 mm) appears to be met based on the amplitude seen
  • This is the primary and most prominent finding
2. ST-T Wave Changes (Strain Pattern)
  • There are downsloping ST segment depressions with T-wave inversions in the lateral leads (I, aVL, V5, V6) - a classic "LV strain pattern" associated with LVH
  • This represents secondary repolarization abnormality due to the hypertrophy
3. Left Axis Deviation (LAD)
  • Lead I shows a predominantly positive deflection
  • Lead II and aVF show relatively smaller/negative complexes
  • This suggests mild left axis deviation
4. Prominent P Waves / Possible Left Atrial Enlargement
  • In lead II, the P waves appear broad and notched (P mitrale pattern), suggesting possible left atrial enlargement - this is a common accompaniment to LVH
5. QRS Widening (Borderline)
  • The QRS complexes appear slightly wide in some leads, possibly indicating a conduction delay (incomplete LBBB or intraventricular conduction delay), though this needs measurement confirmation

Summary

FindingLeads Best Seen
LVH (tall R waves)V5, V6
Deep S wavesV1, V2
ST depression + T inversion (strain)I, aVL, V5, V6
Left axis deviationI, II, aVF
Possible left atrial enlargementII, V1

Clinical Interpretation

This ECG in a 10-year-old female showing LVH with strain pattern is significant and warrants urgent evaluation for:
  • Hypertrophic cardiomyopathy (HCM) - most common cause of LVH with strain in a young patient
  • Aortic stenosis (congenital or rheumatic)
  • Coarctation of the aorta
  • Systemic hypertension (less common in children)
Recommended next steps: Echocardiogram, blood pressure measurement in all four limbs, pediatric cardiology referral.
Note: ECG interpretation should always be confirmed by a qualified clinician with full clinical context.
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