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ECG Analysis - Chugh Multispeciality Hospital
Disclaimer: This is an educational interpretation only and does not constitute medical advice. All ECG findings must be reviewed and confirmed by a qualified physician.
Recorded Parameters (from Image 2)
| Parameter | Value | Normal Range |
|---|---|---|
| Heart Rate (HR) | 98 bpm | 60-100 bpm |
| PR Interval | 114 ms | 120-200 ms |
| QRS Duration | 90 ms | 60-100 ms |
| QT / QTc | 336 / 403 ms | QTc <440 ms (M), <460 ms (F) |
| P / QRS / T axis | 40° / 23° / 43° | All normal |
| RV5 / SV1 | 0.830 / 0.598 mV | - |
| RV5 + SV1 | 1.428 mV | <3.5 mV (Sokolow-Lyon) |
Computer interpretation (partially visible): Sinus rhythm - Normal ECG
Systematic Analysis (14-parameter approach per Harrison's)
1. Rate
98 bpm - upper limit of normal (technically sinus rhythm, borderline tachycardia approaching 100 bpm). Clinically still within normal range.
2. Rhythm
Regular sinus rhythm. P waves are present before every QRS, indicating the impulse originates from the sinoatrial (SA) node.
3. PR Interval - 114 ms (BORDERLINE SHORT)
The normal PR interval is 120-200 ms. At 114 ms, this is just slightly below the lower limit of normal. A PR < 120 ms raises the possibility of:
- Pre-excitation (e.g., Wolff-Parkinson-White - WPW syndrome), which would also show a delta wave
- Enhanced AV nodal conduction (e.g., LGL syndrome)
- Normal variant in some individuals
Looking at the tracing in Image 1, no prominent delta wave is visible, which makes WPW less likely. This may be a normal variant or borderline finding, but it should be noted and correlated clinically.
4. QRS Duration - 90 ms
Normal (< 100 ms = no bundle branch block). QRS morphology appears narrow, meaning ventricular conduction is intact.
5. QT / QTc - 336 / 403 ms
- Raw QT of 336 ms is normal for a rate of 98 bpm
- QTc of 403 ms is within normal limits (normal <440 ms in males, <460 ms in females)
- No prolonged QT - no risk of torsades de pointes from this tracing
6. Electrical Axis
- P axis: 40° - Normal (normal is 0° to +75°)
- QRS axis: 23° - Normal (normal is -30° to +90°). No left or right axis deviation
- T axis: 43° - Normal; concordant with QRS axis
7. Voltages / LVH Assessment
- RV5 + SV1 = 1.428 mV - well below the Sokolow-Lyon threshold of 3.5 mV
- No left ventricular hypertrophy by voltage criteria
8. Lead-by-Lead Observations (Image 1)
Limb leads (I, II, III, aVR, aVL, aVF):
- Upright P waves in I, II, aVF - confirms normal sinus rhythm
- aVR shows inverted P and T (expected in normal)
- No significant ST changes visible
Precordial leads (V1-V6):
- V1-V2: rS pattern (normal for right-sided leads)
- V3-V4: Transitional zone (R/S ratio progression appears normal)
- V5-V6: Dominant R waves (expected left-sided leads)
- R-wave progression appears normal
- No pathological Q waves visible
- No ST elevation or depression suggestive of ischemia
9. Technical Settings
- 0.5 Hz - 350 Hz, AC 50 Hz filter - standard filters applied
- 25 mm/s paper speed - standard
- 10 mm/mV gain - standard calibration
- Simultaneous 12-lead acquisition (MAC 300 machine)
Summary of Findings
| Finding | Assessment |
|---|---|
| Rhythm | Sinus rhythm |
| Rate | 98 bpm (upper normal) |
| PR interval | 114 ms - borderline short, monitor for pre-excitation |
| QRS | Normal - no bundle branch block |
| QTc | 403 ms - normal |
| Axis | Normal in all three (P, QRS, T) |
| LVH | Absent |
| Ischemia | No ST/T changes to suggest ischemia |
| Overall | Normal ECG with a borderline short PR |
Key Clinical Note
The computer interpretation agrees - this is essentially a normal ECG. The only point worth flagging to the treating physician is the PR interval of 114 ms, which is 6 ms below the lower normal limit. If the patient has symptoms like palpitations or syncope, a closer look for delta waves (WPW) or further electrophysiological workup may be warranted. In the absence of symptoms, this is very likely a normal variant.
Per Harrison's Principles of Internal Medicine (22nd ed.), accurate ECG analysis requires correlating with patient age, sex, and clinical status - none of which are visible on this tracing. The treating clinician's review is essential.
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