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ECG interpretation 12 lead normal sinus rhythm

Now let me carefully analyze the ECG image provided. The image shows a 12-lead ECG printed on standard paper (50Hz, 10mm/mV calibration), recorded at a facility in Mirpur, Azad Kashmir. The ECG is rotated 90°, so I need to orient it correctly. The leads visible are V1–V6, I, II, III, aVR, aVL, aVF.
Here is my systematic interpretation:

12-Lead ECG Interpretation

Technical Details

  • Paper speed: 25 mm/s (standard)
  • Calibration: 10 mm/mV (standard, confirmed by calibration pulses visible)
  • Filter: 50 Hz (appropriate for the region)

Systematic Analysis

1. Rate

The R-R intervals appear regular. Counting the complexes across leads, the ventricular rate is approximately 75–90 bpm — within normal range.

2. Rhythm

  • P waves are visible and appear to precede each QRS complex in a 1:1 relationship.
  • Sinus rhythm — regular, with consistent P-P intervals.

3. Axis

  • Looking at leads I and aVF:
    • The QRS in the limb leads appears predominantly upright in I and II.
    • Normal axis (approximately 0° to +90°).

4. P Wave

  • P waves appear present and upright in lead II.
  • Duration and morphology appear normal — no evidence of P mitrale or P pulmonale.

5. PR Interval

  • Appears to be within normal limits (~120–200 ms / 3–5 small squares).
  • No prolonged PR (1st degree AV block) is evident.

6. QRS Complex

  • QRS duration appears narrow (< 120 ms / < 3 small squares).
  • No bundle branch block pattern seen.
  • R-wave progression in precordial leads (V1–V6): R waves appear to increase from V1 to V5/V6, consistent with normal progression. Transition appears around V3–V4.
  • No pathological Q waves are clearly identified in the inferior (II, III, aVF) or lateral (I, aVL, V5, V6) leads.

7. ST Segment

  • ST segments appear to be at the isoelectric baseline across most leads.
  • No obvious ST elevation or depression is seen in the precordial or limb leads.
  • No features of acute STEMI (no tombstoning, no hyperacute T waves with ST elevation in a coronary territory).

8. T Waves

  • T waves appear upright in the lateral and inferior leads.
  • No significant T wave inversions or flattening noted.

9. QT Interval

  • QTc appears within normal limits (< 440 ms in males, < 460 ms in females).

Impression

Normal sinus rhythm with no acute ischemic changes identified.
ParameterFinding
Rate~75–90 bpm
RhythmRegular sinus rhythm
AxisNormal
P wavesNormal
PR intervalNormal
QRSNarrow, normal morphology
R-wave progressionNormal (V1→V6)
ST segmentsIsoelectric — no elevation or depression
T wavesUpright, no inversion
QTcAppears normal

Important Caveats

  1. Image quality and orientation: The ECG is photographed at an angle, which limits precise interval measurement. A direct digital reading or scanned copy would allow more accurate measurements.
  2. Clinical context is essential: A "normal-looking" ECG does not exclude significant pathology. Symptoms (chest pain, syncope, palpitations, dyspnea) must always be correlated.
  3. Subtle findings such as mild ST changes, early repolarization, or borderline hypertrophy patterns are difficult to exclude from a photograph.
  4. This interpretation is not a substitute for formal reporting by a qualified clinician or cardiologist.
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