IMG-20260711-WA0002.jpg
Interpret the ecg
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Reading File
Here is the full ECG interpretation:
ECG Interpretation
Patient: Ranjane | BSL: 159 mg/dl
Machine Parameters (Bionet EKG2000)
| Parameter | Value |
|---|---|
| Heart Rate | ~75-80 bpm |
| PR Interval | 132 ms (normal) |
| QRS Duration | 150 ms (prolonged) |
| QT / QTc | 440 / 519 ms |
| P axis | 42° |
| R axis | 94° |
| T axis | 50° |
| Paper speed | 25 mm/sec, 10 mm/mV |
Rhythm
Normal Sinus Rhythm. Upright P waves precede every QRS in lead II, with a regular P-P interval and normal PR (132 ms). Rate is approximately 75-80 bpm.
Key Finding: Complete Right Bundle Branch Block (CRBBB)
The dominant and most important finding on this ECG is a Complete RBBB, confirmed by:
- QRS duration = 150 ms (must be >120 ms to be "complete")
- RSR' (M-shaped / "rabbit ear") pattern in V1-V2 - the classic fingerprint of RBBB, representing delayed right ventricular depolarization
- Wide, slurred S-waves in leads I, aVL, V5, V6 - delayed right ventricular forces moving away from the lateral leads
- Secondary ST-T changes in V1-V3 - ST depression and T-wave inversion in the right precordial leads. These are discordant (opposite direction to the terminal QRS deflection) and are expected, secondary repolarization changes in RBBB - NOT a sign of ischemia
Axis
- P axis: 42° - Normal
- QRS axis: 94° - Right on the border of normal (normal: -30° to +90°). Minimally rightward, but not frankly abnormal.
- T axis: 50° - Normal
QTc Note
The machine reports QTc = 519 ms, which is prolonged (>450 ms in males, >470 ms in females). However, QTc calculation in the presence of RBBB is notoriously unreliable because the wide QRS artificially inflates the QT measurement. This value should be interpreted with caution and not acted upon in isolation.
Machine Conclusion
"Complete Right Bundle Branch Block - Minimally Abnormal or Normal Variation ECG"
The machine's classification of this as a "minimally abnormal / normal variation" reflects that isolated CRBBB, without other findings, can be seen in normal healthy individuals and does not by itself indicate structural heart disease.
Clinical Interpretation Summary
| Feature | Finding |
|---|---|
| Rhythm | Normal Sinus Rhythm |
| Rate | ~75-80 bpm |
| Conduction | Complete RBBB (150 ms QRS) |
| Ischemia | No acute ST elevation; ST changes in V1-V3 are secondary to RBBB |
| Axis | Normal (mildly rightward) |
| Overall | CRBBB - Minimally Abnormal ECG |
Clinical Significance of CRBBB
CRBBB can be:
- Incidental / normal variant in otherwise healthy individuals (most common when isolated)
- Associated with right ventricular strain (pulmonary embolism, pulmonary hypertension)
- Associated with structural heart disease (ASD, Brugada syndrome, cardiomyopathy, myocarditis)
- Post-procedure (right heart catheterization)
Given the context (BSL 159 mg/dl - borderline/mildly elevated blood sugar), if this patient is diabetic, correlation with clinical symptoms and echocardiography would be advisable to rule out any underlying structural cause. If the patient is asymptomatic with no prior ECG for comparison, a repeat ECG and clinical correlation are recommended.
Disclaimer: This ECG interpretation is for educational purposes. Clinical decisions should be made by a qualified physician in the context of the full patient history and examination.
IMG-20260623-WA0021.jpg
Now this
analyse_media
ECG Interpretation - Post-Thrombolysis (Post-STK) ECG
Clinical Context (Handwritten): "Post STK" - patient status post-streptokinase thrombolysis for an acute MI
Machine Parameters
| Parameter | Value |
|---|---|
| Heart Rate | 82 bpm |
| R-R Interval | 724 ms |
| QRS Duration | 123 ms (wide) |
| QT / QTc | 402 / 472 ms |
| QRS Axis | -57° (Left axis deviation) |
| T Axis | 91° |
| RV5 + SV1 | 0.760 mV |
Machine Diagnosis (Unconfirmed): Ventricular Tachycardia + LVH(?)
The Machine is Wrong - Here's the Correct Interpretation
Finding 1: Accelerated Idioventricular Rhythm (AIVR)
The machine called this "Ventricular Tachycardia" - this is incorrect. The rate is only 82 bpm. True VT requires a rate >100 bpm. At this rate, the correct diagnosis is:
Accelerated Idioventricular Rhythm (AIVR) - rate 60-100 bpm, wide QRS, no preceding P waves
Why this matters clinically: AIVR is a classic, well-recognized reperfusion arrhythmia - it appears within minutes to hours after successful thrombolysis (streptokinase) as the infarcted artery opens and reperfusion occurs. It is generally benign and self-limiting, requires no antiarrhythmic treatment, and is actually a positive sign that the thrombolytic worked. This perfectly matches the handwritten "Post STK" annotation.
ECG features supporting AIVR:
- Wide QRS complexes (~123 ms) with a ventricular/LBBB-like morphology
- Rate 82 bpm (too slow for VT)
- Absent or dissociated P waves
- Regular rhythm
Finding 2: Acute Inferior Wall STEMI
Despite the conduction abnormality, there are clear signs of an acute inferior STEMI still evolving or in the reperfusion phase:
| Lead | Finding |
|---|---|
| II | Deep QS pattern + ST elevation + tall upright T wave |
| III | Deep QS pattern + ST elevation 4-5 mm + tall T wave |
| aVF | Deep QS pattern + ST elevation 3-4 mm |
| I, aVL | Reciprocal ST depression (mirror image) |
| V1-V3 | ST elevation with broad upright T waves |
The ST elevation in II, III, aVF with reciprocal depression in I and aVL is the hallmark of inferior STEMI, consistent with a right coronary artery (RCA) or dominant left circumflex territory occlusion.
Using modified Sgarbossa criteria (for diagnosing MI in the presence of wide QRS/LBBB), the excessively discordant ST changes in the inferior leads strongly support an acute infarction despite the conduction disturbance.
Finding 3: Left Axis Deviation
- QRS axis = -57° (abnormal left axis deviation, normal -30° to +90°)
- Likely reflects inferior wall infarction (loss of inferior forces) rather than a primary conduction disease
Finding 4: LVH? - Unreliable Here
The machine flagged LVH but RV5+SV1 = only 0.760 mV - this does NOT meet the Sokolow-Lyon voltage criterion for LVH (which requires >3.5 mV). The wide QRS from AIVR makes voltage-based LVH criteria unreliable. LVH cannot be diagnosed on this ECG.
Summary Table
| Finding | Interpretation |
|---|---|
| Wide QRS, rate 82 bpm | Accelerated Idioventricular Rhythm (AIVR) |
| ST elevation II, III, aVF | Acute / evolving Inferior STEMI |
| Reciprocal depression I, aVL | Confirms inferior STEMI |
| Left axis deviation (-57°) | Secondary to inferior MI |
| Machine's "VT" label | Incorrect - rate too slow; this is AIVR |
| Machine's "LVH" | Cannot diagnose - voltage insufficient |
Clinical Bottom Line
This ECG shows a patient post-streptokinase thrombolysis for an inferior STEMI, with:
- AIVR - a reperfusion arrhythmia indicating the thrombolytic is working. No treatment needed; monitor.
- Evolving inferior STEMI changes still present - serial ECGs, troponins, and clinical assessment for reperfusion success (resolution of chest pain, ST normalization) are essential.
- If ST elevation is not resolving or patient is hemodynamically unstable, rescue PCI should be considered.
Disclaimer: This interpretation is for educational/clinical support purposes. All decisions must be made by the treating physician in context of the full clinical picture.
IMG-20260630-WA0000(1).jpg
Now this
analyse_media
ECG Interpretation - MICU History Sheet
Patient: Narendra Purandare (recorded as "Paul Dashrath" on machine - likely same patient or label mismatch)
Age/Sex: Male, 49 years | Date: 28/06/2026 | Hospital: SKNMC GH, Pune | Reviewed by: Dr. Aachal Lathi
Machine Parameters
| Parameter | Value | Assessment |
|---|---|---|
| Ventricular Rate | 98 bpm | Borderline sinus tachycardia |
| PR Interval | 96 ms | Short (borderline) |
| QRS Duration | ~69 ms (P/QRS/T: 69/100/195) | Narrow - normal |
| QT / QTc | 368 / 477 ms | QTc mildly prolonged |
| P axis | 73° | Normal |
| QRS axis | 80° | Normal |
| RV5 + SV1 | 0.51 + 0.45 = 0.96 mV | Well below LVH threshold |
ST Level Table (Machine Measured)
| Lead | ST (mV) | Significance |
|---|---|---|
| I | +0.00 | Normal |
| II | -0.01 | Normal |
| III | -0.02 | Normal |
| aVR | +0.00 | Normal |
| aVL | +0.00 | Normal |
| aVF | +0.02 | Normal |
| V1 | +0.04 | Trace, non-significant |
| V2 | +0.02 | Normal |
| V3 | +0.03 | Normal |
| V4 | +0.04 | Trace, non-significant |
No lead shows pathological ST elevation (>0.1 mV / 1 mm) or significant ST depression.
Rhythm
Sinus rhythm at 98 bpm. P waves are upright in I, II, aVF and inverted in aVR - normal sinus origin. Rate is borderline (98 bpm), just under the 100 bpm threshold for sinus tachycardia. This is likely physiologic tachycardia given the MICU context (pain, anxiety, fever, volume depletion).
PR Interval - Short at 96 ms
The PR interval is 96 ms, which is shorter than normal (120-200 ms). Possible causes:
- Normal variant (most common)
- Pre-excitation (WPW syndrome) - look for delta waves at the upstroke of the QRS; not clearly evident here
- LGL syndrome (Lown-Ganong-Levine) - short PR with normal narrow QRS, no delta waves
- Clinical correlation recommended; if delta waves are suspected, a higher quality/closer ECG would help
QRS Complexes
- Narrow (69 ms) - no bundle branch block
- Normal axis (~80°)
- Normal R-wave progression across V1-V6 (small r in V1, growing to dominant R in V4-V6)
- No pathological Q waves in any territory
ST Segments & T Waves
- ST segments are essentially isoelectric across all leads
- The minimal ST changes in V1-V4 (+0.02 to +0.04 mV) are sub-millimeter and non-pathological
- T waves are upright and concordant in all expected leads (I, II, aVF, V2-V6)
- No hyperacute T waves, no deep symmetric T inversions, no Wellens pattern
Key Negatives (Important in MICU Context)
| Feature | Finding |
|---|---|
| Acute STEMI | Absent - no significant ST elevation |
| NSTEMI/Ischemia | Absent - no ST depression or T inversion |
| Pathological Q waves | Absent |
| LVH | Absent (voltage 0.96 mV, far below 3.5 mV threshold) |
| Bundle branch block | Absent (QRS narrow) |
| Complete WPW | Not clearly evident |
QTc Note
QTc = 477 ms - this is mildly prolonged (normal <450 ms in males). In a MICU patient, this warrants:
- Review of all QT-prolonging medications (antibiotics like azithromycin, antifungals, antiemetics like ondansetron, antipsychotics)
- Check electrolytes: potassium, magnesium, calcium
- Serial ECG monitoring if QTc exceeds 500 ms
Summary
Overall: Sinus rhythm at 98 bpm with a short PR interval, mildly prolonged QTc (477 ms), no acute ischemic changes, no MI, no conduction block.
This is a near-normal ECG in the context of a MICU admission. The main actionable findings are:
- Short PR (96 ms) - investigate for pre-excitation / LGL; clinically correlate
- Mildly prolonged QTc (477 ms) - audit QT-prolonging drugs and check electrolytes
- Rate 98 bpm - identify and treat the underlying cause of borderline tachycardia
Disclaimer: For educational and clinical support purposes only. Final interpretation rests with the treating physician.
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