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ECG Interpretation

Technical details: 12-lead ECG, paper speed 25 mm/s, gain 10 mm/mV, AC 50Hz filter + EMG 25Hz + DFT

Rate

The RR intervals appear regular and short. Counting complexes across a 10-second strip gives approximately 100-110 beats per minute - consistent with sinus tachycardia.

Rhythm

  • Regular R-R intervals
  • P waves are present and precede every QRS complex
  • Normal sinus rhythm with tachycardia (~100-110 bpm)

Axis

  • Lead I: positive QRS
  • Lead aVF: positive QRS
  • Normal axis (0° to +90°)

P Waves

  • Present and upright in leads I, II, aVF
  • Inverted in aVR (normal)
  • Morphology appears normal - no bifid or peaked P waves suggesting atrial enlargement

PR Interval

  • Appears approximately 160-180 ms (normal: 120-200 ms)
  • Normal PR interval - no heart block

QRS Complex

  • Duration appears narrow (~80-100 ms) - no bundle branch block
  • Tall R waves in I, II, III, V4-V6
  • Prominent tall R waves visible in the precordial leads (V1-V6), particularly in V4-V5
  • No pathological Q waves evident

ST Segment & T Waves

  • ST elevation is present in multiple leads - particularly visible in the limb leads (I, II, III, aVF) and chest leads
  • The ST segments appear concave upward (saddle-shaped) or diffusely elevated
  • T waves appear tall/peaked in several leads
  • In aVR: there appears to be ST depression (reciprocal)
This pattern of diffuse ST elevation across multiple lead territories (limb leads + precordial) without the focal pattern of a typical STEMI (which would respect a single coronary territory) is very suspicious for:

Key Findings Summary

ParameterFinding
Rate~100-110 bpm (sinus tachycardia)
RhythmRegular, normal sinus
AxisNormal
PR intervalNormal
QRS durationNarrow (normal)
ST segmentsDiffuse ST elevation
T wavesTall, upright in multiple leads
Reciprocal changesST depression in aVR

Differential Diagnosis

Most likely: Acute Pericarditis
  • Diffuse ST elevation in multiple lead territories (not confined to one coronary artery distribution)
  • Concave/saddle-shaped ST elevation
  • PR depression may be present (look carefully in lead II)
  • Sinus tachycardia (can accompany pericarditis due to pain/inflammation)
Also consider:
  1. Early Repolarization - benign variant, concave ST elevation, typically in young adults; no PR depression
  2. Acute STEMI (multi-vessel or left main disease) - less likely given diffuse, non-territorial pattern, but must be excluded clinically
  3. Takotsubo (stress) cardiomyopathy - can show diffuse changes
  4. Hyperkalemia - peaked T waves (though pattern here is more ST elevation)

Clinical Recommendation

This ECG requires urgent clinical correlation. If the patient presents with chest pain, fever, or recent viral illness - acute pericarditis is the top diagnosis. Troponin, echocardiogram, and inflammatory markers (CRP, ESR) should be obtained. If any doubt exists about STEMI, emergent cardiology consultation is warranted.
⚠️ This is an automated ECG analysis for educational purposes and does NOT replace clinical evaluation by a qualified physician.
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