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)

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)

Summary Table

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 a Heart Attack on This ECG?

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

What This ECG Shows (and Does NOT Show)

• Sinus tachycardia (~110 bpm)
• Occasional VPBs (premature ventricular beats - not a sign of heart attack by themselves)
• Left axis deviation

• 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

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