Orris
attachment

Analysis

Reading File
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Here is a thorough analysis of this ECG:

ECG Analysis

Patient & Technical Details (from the machine printout)

  • Date/Time: 26-05-14, 07:37:36 (likely 26 May 2014)
  • Paper speed: 25 mm/s
  • Gain: 10 mm/mV
  • Heart Rate (HR): ~110 bpm
  • PR interval: ~149 ms
  • QRS duration: ~95 ms
  • QT/QTc: approximately 340/407 ms (within normal limits)
  • P/R/T Axis: P axis, R/S(V1), V3:S(V1) values listed

Machine Conclusions (printed on the ECG)

The machine has auto-interpreted:
  1. Sinus tachycardia
  2. Occasional VPBs (Ventricular Premature Beats)
  3. Longitudinal left axis deviation
  4. "Report: need physician confirmation"

Manual Review of Findings

1. Sinus Tachycardia (~110 bpm)

  • The rhythm appears regularly irregular with a dominant rate of ~110 bpm
  • P waves are present before each QRS in the limb leads, consistent with sinus origin
  • At 25 mm/s, each large square = 200 ms; each small square = 40 ms

2. Occasional VPBs (Ventricular Premature Beats)

  • A VPB (also called a PVC - premature ventricular complex) is a beat arising from ventricular ectopic focus
  • It appears as a wide, bizarre QRS complex without a preceding P wave
  • The machine identifies these as occasional, meaning fewer than 5-6 per minute
  • Clinical significance: Occasional VPBs in isolation (without structural heart disease) are usually benign
  • Features to assess: unifocal vs. multifocal, presence of compensatory pause, coupling interval

3. Left Axis Deviation (LAD)

  • LAD is defined as QRS axis between -30° and -90°
  • On ECG: positive (upright) QRS in lead I + negative (downward) QRS in lead aVF
  • Common causes of LAD:
    • Left anterior fascicular block (LAFB) - most common cause of significant LAD
    • Left ventricular hypertrophy (LVH)
    • Inferior MI (old)
    • Pre-excitation (WPW)
    • Hyperkalemia
    • Congenital heart disease (ASD primum type)
The machine uses the term "longitudinal" LAD, which suggests a moderate/persistent axis shift rather than transient.

Summary Table

ParameterFindingClinical Relevance
Rate~110 bpmSinus tachycardia - investigate cause (pain, fever, anemia, thyroid, dehydration, anxiety)
RhythmSinus with occasional ectopicsVPBs - usually benign if occasional
AxisLeft axis deviationConsider LAFB, LVH
PR interval~149 msNormal (120-200 ms)
QRS duration~95 msNormal (<120 ms)
QTc~407 msNormal (<450 ms male, <460 ms female)
ST/T changesDifficult to assess from imageNo overt ST elevation/depression visible

Clinical Recommendations

  1. Investigate the cause of sinus tachycardia - check for fever, pain, hypovolemia, anemia, thyrotoxicosis, anxiety, or drugs (e.g., salbutamol, caffeine)
  2. Evaluate for structural heart disease - given LAD + occasional VPBs, an echocardiogram is advisable to rule out LVH, cardiomyopathy, or regional wall motion abnormality
  3. Correlate clinically - the machine's notation "Report: need physician confirmation" means this auto-interpretation must not be used as a standalone diagnosis
  4. Monitor VPBs - if symptoms (palpitations, presyncope) accompany the VPBs, or if they are frequent/complex on a 24-hour Holter monitor, further evaluation is warranted
  5. Check electrolytes - hypokalemia and hypomagnesemia are common reversible causes of VPBs
Disclaimer: This is an educational ECG interpretation tool. All findings must be confirmed by a qualified physician before any clinical decisions are made. The machine itself has flagged this for physician review.

Is there heart attack

Finding Sources
Reading File

Is There a Heart Attack on This ECG?

Based on the available findings: No clear signs of an acute heart attack are visible on this ECG. Here is the detailed reasoning:

What We Look for on an ECG to Diagnose a Heart Attack

A heart attack (myocardial infarction) shows one or more of these classic signs:
SignWhat it Means
ST elevationRaised ST segment in 2+ consecutive leads = acute STEMI (heart attack in progress)
New Q wavesDeep, wide Q waves = old/completed infarction (tissue death)
ST depressionCan indicate NSTEMI or ischemia (reduced blood flow)
T wave inversionCan indicate ischemia or evolving infarction
New LBBBNew left bundle branch block = treated as STEMI equivalent

What This ECG Shows (and Does NOT Show)

What IS present:
  • Sinus tachycardia (~110 bpm)
  • Occasional VPBs (premature ventricular beats - not a sign of heart attack by themselves)
  • Left axis deviation
What is NOT seen on this ECG:
  • No ST elevation in any lead group (no STEMI pattern)
  • No obvious pathological Q waves (no evidence of old completed infarction)
  • No widespread ST depression suggestive of NSTEMI
  • The machine's auto-conclusions (tachycardia, VPBs, left axis deviation) do NOT include any ischemia or infarction flags

Important Caution

However, ECG alone cannot fully rule out a heart attack. This is because:
  1. NSTEMI (a type of heart attack) can occur with a completely normal-looking ECG - diagnosis requires blood tests called troponin (cardiac enzymes)
  2. The image quality is limited (photo of paper at an angle), making it difficult to assess subtle ST or T wave changes with 100% certainty
  3. Some heart attacks (posterior wall, right ventricular) can be missed on a standard 12-lead ECG

Bottom Line

This ECG does not show obvious signs of a heart attack. The main findings are sinus tachycardia, occasional extra beats (VPBs), and left axis deviation.
If the patient has chest pain, shortness of breath, sweating, or arm/jaw pain - please go to a hospital immediately for blood tests (troponin) and physician evaluation. An ECG alone is not enough to rule out a heart attack.
  • Tintinalli's Emergency Medicine, ECG Criteria for AMI section
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