IMG-20260623-WA0002.jpg
Interpret the ecg
analyse_media
ECG Interpretation
Date recorded: 2025-05-31 | Speed: 25 mm/s | Gain: 10 mm/mV
Measured Parameters
| Parameter | Value | Comment |
|---|---|---|
| Heart Rate | 57 BPM | Sinus bradycardia |
| PR Interval | 128 ms | Normal |
| QRS Duration | 158 ms | Markedly prolonged |
| QT / QTc | 496 ms / 486 ms | Prolonged |
| P axis | -5° | Normal |
| QRS axis | -21° | Mild left axis deviation |
| T axis | 84° | |
| RV5 / SV1 | 2.34 / 0.61 mV |
Rhythm
Regular sinus rhythm at 57 BPM. P waves are upright in I, II, aVF and inverted in aVR, confirming sinus origin.
Key Morphological Findings
Lateral leads (I, aVL, V5, V6):
- Broad, monophasic, notched (M-shaped) R waves
- No septal Q waves
- ST depression with T-wave inversion (discordant secondary change)
Right precordial leads (V1-V3):
- Deep, wide QS complexes (no initial r-wave)
- ST elevation with tall upright T waves (discordant secondary change)
Lead III, aVR, aVF:
- Deep, wide rS or QS complexes
Diagnosis
Complete Left Bundle Branch Block (LBBB)
This satisfies all three Sgarbossa-independent criteria for LBBB:
- QRS duration >= 120 ms (here 158 ms - complete LBBB threshold is 120 ms)
- Broad, notched monophasic R waves in lateral leads (I, aVL, V5, V6) with absent septal Q waves
- Discordant ST-T changes throughout (ST elevation in V1-V3, ST depression/T inversion in V5-V6)
Clinical Implications
New LBBB should always raise concern for:
- Acute MI - In the setting of chest pain, new LBBB is a STEMI-equivalent and warrants urgent cath lab activation. Apply modified Sgarbossa criteria (concordant ST elevation >= 1 mm, concordant ST depression >= 1 mm in V1-V3, or discordant ST elevation >= 25% of preceding S wave) to screen for superimposed ischemia.
- Dilated cardiomyopathy - LBBB is a common finding; if present with reduced EF, the patient may qualify for cardiac resynchronization therapy (CRT).
- Aortic stenosis, hypertensive heart disease - Common structural causes.
- Rate-related (phase 3) LBBB - Less likely here given the bradycardic rate (57 BPM).
QTc of 486 ms is prolonged and warrants attention - though in LBBB, QTc prolongation is partly an artifact of the wide QRS and should be interpreted cautiously.
The bradycardia (57 BPM) in the context of LBBB may indicate significant underlying conduction system disease. Consider Holter monitoring to assess for higher-degree AV block or pauses.
Clinical note: This ECG interpretation is an educational analysis and must be correlated with the patient's symptoms, history, prior ECGs, and clinical context. A new LBBB in a symptomatic patient is a medical emergency until proven otherwise.
IMG-20260630-WA0016.jpg
Interpret this
analyse_media
This is the same ECG as the one you submitted previously - same patient (Yevale Rangubai), same recording date/time (2025-05-31 08:18:47), same facility (SKNMC GH), and identical measurements. The interpretation is unchanged, but here is a complete standalone report:
ECG Interpretation - Yevale Rangubai
Recorded: 2025-05-31 08:18:47 | Facility: SKNMC GH | Speed: 25 mm/s | Gain: 10 mm/mV
Measured Parameters
| Parameter | Value | Comment |
|---|---|---|
| Heart Rate | 57 BPM | Sinus bradycardia |
| PR Interval | 128 ms | Normal |
| QRS Duration | 158 ms | Markedly prolonged |
| QT / QTc | 496 / 486 ms | Prolonged (partly artefactual in LBBB) |
| P axis | -5° | Normal |
| QRS axis | -21° | Mild left axis deviation |
| T axis | 84° | |
| RV5 / SV1 | 2.34 / 0.61 mV |
ST levels (automated): I: -0.07 | II: -0.01 | III: +0.06 | V1: +0.04 | V2: +0.03 | V3: +0.31 mV
Rhythm
Regular sinus rhythm at 57 BPM. P waves upright in I, II, aVF and inverted in aVR confirm sinus origin. Constant PR interval of 128 ms.
QRS Morphology
Lateral leads (I, aVL, V5, V6):
- Broad, monophasic, notched (M-shaped) R waves
- Absent septal Q waves
- Discordant ST depression with asymmetric T-wave inversion
Right precordial leads (V1, V2, V3):
- Deep, wide QS complexes (no initial r wave)
- Discordant ST elevation with tall upright T waves (V3 most prominent at 3.1 mm)
Inferior leads (III, aVF):
- Deep, wide rS/QS complexes
Primary Diagnosis
Complete Left Bundle Branch Block (LBBB)
All diagnostic criteria fulfilled:
- QRS >= 120 ms (here 158 ms)
- Monophasic notched R waves in I, aVL, V5, V6 with absent Q waves
- QS complexes in V1-V3
- Appropriate discordant ST-T changes throughout
Sgarbossa Criteria Assessment (Screening for Superimposed Ischemia)
| Criterion | Finding | Score |
|---|---|---|
| Concordant ST elevation >= 1 mm (any lead with positive QRS) | Absent | 0 |
| Concordant ST depression >= 1 mm in V1-V3 | Absent | 0 |
| Discordant ST elevation >= 25% of S-wave depth (Modified Sgarbossa) | V3: ~3 mm elevation vs. deep S (~15-20 mm) = ratio ~0.15-0.20 - below 0.25 threshold | Negative |
Modified Sgarbossa: Negative - The ST elevation in V1-V3 is proportionate to the deep QS complexes and consistent with expected secondary LBBB repolarization changes, rather than acute MI. However, this must always be interpreted alongside the patient's symptoms and clinical context.
Clinical Considerations
- Is this LBBB new or old? - This is the most important clinical question. A new LBBB in a patient with chest pain is treated as a STEMI-equivalent.
- Bradycardia (57 BPM) + LBBB - Suggests significant conduction system disease. Risk of complete heart block if the right bundle is also diseased (bifascicular/trifascicular disease). Holter monitoring and echocardiography are indicated.
- Prolonged QTc (486 ms) - Largely artefactual in LBBB but review the medication list for QT-prolonging drugs.
- If EF is reduced - Patient may be a candidate for Cardiac Resynchronization Therapy (CRT), particularly with LBBB morphology and QRS >= 150 ms.
Note: This is the same ECG as the one you submitted in your previous message. If you intended to compare two different ECGs, please check whether you may have uploaded the same image twice.This analysis is for educational purposes only and requires clinical correlation by the treating physician.
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