ECG Interpretation - Aster Medical Center

Recorded Measurements (Machine-Reported)

Rhythm

• Upright P waves in I, II, aVF; inverted in aVR - consistent with a normal sinus origin.
• P axis 33° - normal.
• Regular P-P and R-R intervals.

Intervals

• PR 162 ms - within normal range (120-200 ms), no conduction delay.
• QRS 114 ms - mildly prolonged (normal <110 ms). Does not meet full bundle branch block criteria (threshold 120 ms), but suggests intraventricular conduction delay. The morphology should be assessed for RBBB/LBBB pattern.
• QTc 423 ms - normal (males <440 ms, females <460 ms).

Axis

• QRS axis +53° - normal (within -30° to +90°).
• T-wave axis -8° - slightly leftward, contributing to the QRS-T angle, which warrants attention in the context of LVH.

Key Findings

1. Left Ventricular Hypertrophy (LVH) - Meets Sokolow-Lyon Criteria

• RV5 + SV1 = 3.57 mV (35.7 mm) -- exceeds the 35 mm threshold.
• Important note: The precordial leads (V1-V6) are recorded at half-standardization (5 mm/mV) instead of the standard 10 mm/mV. The machine's computed amplitudes already account for this, so the reported 3.57 mV is the true voltage. The visual deflections on paper are smaller than they appear, but the actual voltages are high.
• The tall R waves in V4-V6 and deep S waves in V1-V2 are consistent with LVH voltage pattern.

2. Borderline QRS Duration (114 ms)

• Just under the 120 ms threshold for a full bundle branch block. This mild intraventricular conduction delay is commonly seen in LVH.

3. T-wave Changes

• T-wave inversions in V1 and V2 - can be a normal finding, but in the context of LVH, this raises the possibility of a LVH strain pattern extending into the right precordial leads.
• T waves in III and aVL are flat to mildly inverted - minor, likely positional.
• No ST elevation or depression to suggest acute ischemia.

4. No Acute Ischemic Changes

• ST segments are isoelectric across all leads.
• No pathological Q waves identified.
• No ST elevation or reciprocal depression pattern suggestive of STEMI/NSTEMI.

Summary Interpretation

Normal sinus rhythm, 98 bpm. Borderline QRS prolongation (114 ms). Meets Sokolow-Lyon voltage criteria for Left Ventricular Hypertrophy (RV5+SV1 = 3.57 mV). T-wave inversions in V1-V2, possibly representing early strain or normal variant. No acute ischemic changes.

Clinical Correlation Recommended

• Hypertension (most common cause)
• Hypertrophic cardiomyopathy
• Aortic stenosis / valvular disease
• Athletic heart (physiological)