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Interpret

Reading File
analyse_media
ECG interpretation (photographed tracing, so fine detail is limited)
Machine-printed values
  • Ventricular rate: 94 bpm
  • PR interval: 182 ms (normal)
  • QRS duration: 90 ms (normal)
  • QT/QTc: 392/452 ms (QTc is borderline to mildly prolonged)
  • P/QRS/T axes: 44/15/102 degrees
  • Machine read: "Borderline ECG" and "Lateral ST-T abnormality is nonspecific". The first line of the statement is hidden by the gloved finger and is unconfirmed.
My read
  • Rhythm: Sinus rhythm, with a P wave before each QRS and a constant PR interval. The R-R intervals look essentially regular, with perhaps slight variation. The rate of about 94 bpm is at the upper end of normal. I see no pauses and no AV block.
  • Axis: Normal. The QRS axis of 15 degrees fits lead I upright, with small complexes in II and aVF and a predominantly negative QRS in III. This is a normal variant and not left axis deviation. The T axis of 102 degrees is rightward, which is why the T waves in I and aVL are flat or low.
  • QRS: Narrow at 90 ms, with no bundle branch block and no pre-excitation. No obvious pathological Q waves. Lead III shows a deep negative deflection, which is common at this axis. R-wave progression across V1 to V6 looks acceptable.
  • ST-T: Lateral leads (I, aVL, V5, V6) show low-amplitude or flattened T waves with no clear ST elevation. This matches the machine's "nonspecific lateral ST-T abnormality". Lead III shows a flat or inverted T. I cannot reliably call ST depression or elevation in the V1 to V4 area, because the V3/V4 segment has a large baseline-wander artifact from patient movement or a loose electrode.
  • Voltage: No obvious LVH or RVH by voltage.
  • Overall: Sinus rhythm, normal axis, normal intervals apart from a borderline QTc, and nonspecific lateral T-wave flattening. I see no STEMI pattern, no high-grade block and no malignant arrhythmia.
Limits of this read
  • The image is tilted and parts of the tracing are distorted. The V3 to V5 artifact makes the ST segments there unreliable.
  • I could not read the handwritten notes at the top.
  • Nonspecific T-wave changes do not exclude ischemia. A normal or nonspecific ECG can occur early in ACS.
Suggested next steps
  • Match the ECG to the clinical picture. If there is chest pain or dyspnea, repeat the ECG in 15 to 30 minutes, record V3 to V6 again with good contact, and send serial high-sensitivity troponin.
  • Check potassium, magnesium and calcium, and review QT-prolonging drugs (borderline QTc 452 ms). Lateral T flattening can also reflect electrolyte disturbance, hyperventilation, anxiety, a drug effect or a normal variant.
  • Compare with any old ECGs. A change from baseline is more meaningful than the nonspecific finding itself.
Please share the patient's age, sex and symptoms, or a clearer flat photo. I can then give a more specific read.
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