ECG Interpretation

• HR: 132 bpm (or possibly 76 bpm - there appear to be two values; 76 bpm is likely the correct ventricular rate)
• PR interval: 132 ms
• QRS duration: 398 ms (this is a very wide complex if accurate - possibly a machine misread; see below)
• QT/QTc: 398/392 ms
• P/QRS/T axis: 66° / 47° / 41°
• RV5/SV1 amplitude: 1.50 / 1.06 mV
• RV5+SV1: 2.56 mV
• Filter: H50
• Paper speed: 25 mm/s, 10 mm/mV
• Note on sticky label: GRBs, 88 mg/dL (likely blood glucose)
• Institution: Aster Medical Center

Systematic Analysis

• Regular R-R intervals are present.
• P waves appear to be present and upright in leads I and II, consistent with normal sinus rhythm.

• QRS axis: +47° - this is normal (normal range: -30° to +90°).
• No axis deviation.

• PR interval: ~132 ms - normal (120-200 ms).
• P waves appear morphologically normal.

• The machine-printed QRS duration value of 398 ms would indicate an extremely wide complex (essentially a ventricular rhythm), but visually the QRS complexes do not appear that broad. This may be a machine artifact or misread. Visually, QRS appears borderline or mildly widened - look for this carefully on the original paper.
• In the precordial leads (V1-V6), there are tall R waves in V5-V6 and deep S waves in V1-V2.
• RV5+SV1 = 2.56 mV (25.6 mm) - approaching but just below the Sokolow-Lyon threshold of 35 mm for LVH. However, Cornell criteria (SV3 + RaVL) should also be calculated.

• There appears to be ST depression and/or T wave inversion in the lateral leads (I, aVL, V5, V6), which is the classic "strain pattern" associated with left ventricular hypertrophy.
• In V1-V3, there appear to be tall/positive T waves (secondary repolarization changes).

• Sokolow-Lyon: SV1 + RV5 or RV6 ≥ 35 mm → The machine reads RV5+SV1 = 25.6 mm (below threshold of 35 mm), but may still be significant depending on age/body habitus.
• Cornell criterion: SV3 + RaVL > 28 mm in men, >20 mm in women - cannot be fully calculated without the exact V3 S-wave and aVL R-wave measurements, but aVL axis of 66° and the visible morphology are relevant.
• Repolarization (strain pattern): The ST-T changes in lateral leads, if present, add significant weight toward LVH by Romhilt-Estes scoring (+3 points for strain).

• QT: 398 ms, QTc: 392 ms - normal (QTc <450 ms in men, <460 ms in women).

Summary / Impression

Clinical Correlation

• LVH with strain is most commonly seen with hypertension, aortic stenosis, or hypertrophic cardiomyopathy.
• The blood glucose noted on the label (88 mg/dL) is within normal fasting range.
• The wide QRS printed value (398 ms) is likely a machine error or artifact - the paper should be reviewed carefully to rule out LBBB (left bundle branch block), as severe LVH can mimic LBBB morphologically.
• Echocardiography is recommended to confirm LVH and assess left ventricular wall thickness and function.

Disclaimer: This interpretation is for educational purposes. All ECGs should be formally reviewed by a qualified physician in the context of the patient's full clinical history. Do not make treatment decisions based solely on this analysis.

• Goldman-Cecil Medicine, p. 427 (Chamber Hypertrophy, Sokolow-Lyon and Cornell voltage criteria for LVH)