Give conclusion of this ecg
Reading File
Let me analyze this ECG carefully from the image provided.
ECG Metadata (from the strip):
- Machine: SEMIP V190
- Settings: 25mm/s paper speed, 10mm/mV, 2×5.0c+I rhythm, SMART6 1.14
- Filter: 0.25–25 Hz, PT50
- Patient: Female, 76 years old (Женский, 76 лет)
- Date: 18-05-2026
ECG Analysis & Conclusion
Rate
- Paper speed 25 mm/s. The RR intervals appear to vary across the strip, with an average ventricular rate of approximately 55–65 bpm (bradycardic to low-normal range).
Rhythm
- The rhythm is irregular. P waves are visible but the PP and RR intervals vary. This pattern is consistent with sinus arrhythmia or atrial fibrillation with slow ventricular response — however, distinct P waves appear to be present in some leads (notably Lead II and aVF), favoring sinus rhythm with frequent ectopy or sinus arrhythmia.
Axis
- In the limb leads, looking at I and aVF: Lead I appears positive, aVF appears low-amplitude/isoelectric → Normal axis to possibly left axis deviation (LAD).
P Waves
- P waves are visible, appearing broader than normal in some leads — possible left atrial enlargement (LAE) / P mitrale pattern.
PR Interval
- Appears prolonged (>200 ms / 5 small squares at 25 mm/s) — suggesting 1st degree AV block.
QRS Complex
- QRS duration appears widened (≥120 ms / 3 small squares) in multiple leads.
- In V1–V2: broad, predominantly negative (rS or QS pattern).
- In V5–V6, I, aVL: broad, predominantly positive (broad R).
- This morphology is consistent with Left Bundle Branch Block (LBBB).
ST Segment & T Waves
- In the context of LBBB, ST-T changes are expected (secondary/discordant changes — ST depression and T-wave inversion in leads with dominant R waves; ST elevation in leads with dominant S waves). This is a normal consequence of LBBB and does not independently indicate ischemia by conventional criteria.
- However, in V1–V3 there appears to be ST elevation, which in LBBB may warrant Sgarbossa criteria assessment if ACS is suspected.
Other
- No overt delta waves.
- QT appears prolonged — partly due to the wide QRS in LBBB.
CONCLUSION
| Finding | Detail |
|---|---|
| Rhythm | Sinus rhythm (possible sinus arrhythmia) |
| Rate | ~55–65 bpm (low-normal / relative bradycardia) |
| Conduction | 1st degree AV block (prolonged PR); Left Bundle Branch Block (LBBB) |
| Axis | Normal to left axis deviation |
| Hypertrophy | Possible left atrial enlargement |
| ST-T changes | Secondary to LBBB (expected discordant changes) |
Summary Statement:
Sinus rhythm with 1st degree AV block and complete Left Bundle Branch Block (LBBB). Rate 55–65 bpm. Possible left atrial enlargement. ST-T changes secondary to LBBB.
⚠️ Clinical Note: LBBB is a significant finding in a 76-year-old woman. It may be:
- New LBBB → must be treated as ACS equivalent if accompanied by chest pain (Sgarbossa criteria apply)
- Chronic LBBB → associated with cardiomyopathy, hypertensive heart disease, or conduction system disease
Correlation with prior ECGs, clinical symptoms, cardiac biomarkers (troponin), and echocardiography is strongly recommended. This interpretation should be confirmed by a qualified cardiologist.
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