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Interpret
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Reading File
Here is a full interpretation of this 12-lead ECG:
ECG Interpretation
Patient: elangeshwri | Facility: Health Haven | Date: 19/07/2026
Settings: 25 mm/s paper speed | 10 mm/mV sensitivity | 0.5-35 Hz filters | 50 Hz AC filter
Technical Quality
- Significant baseline wander present across all limb leads (especially I, III, aVL)
- Muscle tremor artifact throughout, most prominent in III, aVL, aVF
- These artifacts limit confident assessment of P-wave morphology and subtle ST/T changes
Rhythm & Rate
| Parameter | Finding |
|---|---|
| Rhythm | Irregularly irregular |
| Rate | ~55-65 bpm (slow-to-moderate ventricular response) |
| P waves | No discrete, consistent P waves identifiable before each QRS |
| PR interval | Cannot be measured |
Primary rhythm diagnosis: Atrial Fibrillation (AF) with controlled ventricular response
The irregularly irregular rhythm with absent P waves and variable R-R intervals is the hallmark. The rate of ~55-65 bpm suggests either good rate control (on beta-blocker/digoxin/rate-limiting CCB) or an inherently slow AV nodal conduction.
Cardiac Axis
- Lead I: predominantly positive QRS
- aVF: predominantly positive QRS
- Normal axis (0° to +90°)
QRS Morphology
| Lead Group | Findings |
|---|---|
| V1, V2, V3 | QS or rS morphes (predominantly negative) |
| V4 | Transitional - mostly negative (rS) |
| V5, V6 | Positive/upright QRS (monophasic R) |
The pattern of QS/rS in V1-V3 with upright QRS in V5-V6 raises two possibilities:
- Right Ventricular Pacing (RVA pacing) - the LBBB-like morphology with left bundle branch block pattern and left-axis shift is classic for RV apex pacing. The calibration squares (x1mv pulses visible at the strip edges) and the morphology strongly suggest ventricular pacing spikes may be present.
- Anterior wall ischemia / old anterior MI with poor R-wave progression (if no pacer spikes)
Without being able to definitively identify pacing spikes at this resolution, both possibilities should be considered. If pacing spikes are confirmed, this is a paced rhythm in AF.
ST Segments & T Waves
- Difficult to assess reliably due to baseline wander and artifact
- No obvious hyperacute ST elevation visible
- T-wave changes cannot be confidently characterized
Summary & Interpretation
Primary Diagnosis:
Atrial Fibrillation with controlled ventricular rate (~60 bpm)
Secondary finding to investigate:
QS pattern in V1-V3 with possible RVA pacing OR poor R-wave progression (anterior ischemia/old anterior MI) - clinical correlation required
Clinical Recommendations
- Correlate with prior ECGs - is this a new AF or known chronic AF?
- Check for pacemaker - the x1mv calibration pulses and QRS morphology suggest possible pacing; look for device
- Troponin / cardiac biomarkers if anterior MI is suspected
- Rate control assessment - rate is well-controlled; confirm current medications
- Anticoagulation status - all AF patients need CHA₂DS₂-VASc scoring for stroke risk
- Repeat ECG with better patient relaxation to reduce muscle artifact
⚠️ Disclaimer: This interpretation is for educational/clinical decision-support purposes only. All ECG findings must be confirmed and acted upon by a qualified clinician in the context of full patient history and examination.
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ECG Interpretation - Second Recording
Patient: elangeshwri | ID: 0260719055938 | Facility: Health Haven | Doctor: Bijin
Settings: 25 mm/s | 10 mm/mV | 0.5-35 Hz | AC: 50 Hz
Comparison Note
This appears to be a second ECG of the same patient (elangeshwri, Health Haven), recorded shortly after or alongside the first. The ID suffix differs (055938 vs 055637), suggesting these are two sequential recordings.
Technical Quality
- Computer-generated interval measurements are partially visible at the bottom of the precordial strip (QRS, PR, QT/QTc, RVS/SVT, QTof)
- Some baseline artifact present, but overall quality is better than the first recording
- Calibration pulses (x1mv) are clearly visible at the start of each channel
Rhythm & Rate
| Parameter | Finding |
|---|---|
| Rhythm | Irregularly irregular |
| P waves | Absent - no consistent P waves before QRS complexes |
| Rate | ~60-75 bpm (ventricular response) |
| Fibrillatory baseline | Present in limb leads |
Primary rhythm: Atrial Fibrillation - consistent with the first ECG. Irregularly irregular rhythm with absent P waves confirmed in leads I, II, III, aVR, aVL, aVF.
Cardiac Axis
| Lead | QRS Polarity |
|---|---|
| Lead I | Predominantly positive |
| aVF | Predominantly positive |
| Axis | Normal (0° to +90°) |
QRS Morphology - Precordial Leads
| Lead | Morphology |
|---|---|
| V1 | Small r or rS complex - predominantly negative |
| V2 | rS - predominantly negative with deeper S |
| V3 | rS - transitional |
| V4 | Transitional zone - small R beginning to emerge |
| V5 | Taller R wave - positive deflection |
| V6 | Positive, upright R wave |
R-wave progression: Poor in V1-V3, with transition occurring around V4-V5.
The pattern is consistent with what was seen in the first ECG: QS/rS in right precordial leads, upright in lateral leads - again raising the differential of:
- Right ventricular apical (RVA) pacing with LBBB-like morphology
- Poor R-wave progression from anterior ischemia or old anterior MI
Limb Lead Analysis
- Lead I: Low amplitude, relatively flat - small biphasic or positive QRS
- Lead II: Variable R-R intervals confirming AF; QRS upright
- Lead III: Predominantly negative/biphasic QRS morphology with noisy baseline
- aVR: Negative QRS (expected in normal axis)
- aVL: Low amplitude or flat QRS (isoelectric - consistent with near-perpendicular axis)
- aVF: Positive QRS - confirms normal/inferior axis
ST Segments & T Waves
- No obvious ST elevation in any lead
- T-wave morphology is difficult to assess definitively due to artifact and AF
- No hyperacute changes identified
Computer Measurements (partially legible)
The printed measurements at the bottom include QRS duration, PR interval (not measurable in AF), QT/QTc, and RVS/SVT notation - the specific values are partially cut off, but these auto-measurements should be reviewed against clinical context.
Summary Comparing Both ECGs
| Feature | ECG 1 (ID ...637) | ECG 2 (ID ...938) |
|---|---|---|
| Rhythm | AF, controlled (~60 bpm) | AF, controlled (~65-75 bpm) |
| Axis | Normal | Normal |
| R-wave progression | Poor V1-V3 | Poor V1-V3 |
| ST changes | Not clearly seen | Not clearly seen |
| Overall | Same diagnosis | Confirms findings |
Overall Clinical Impression (Both ECGs Combined)
Primary Diagnosis:
Atrial Fibrillation with controlled ventricular rate
Key Associated Finding:
Persistent poor R-wave progression V1-V3 across both recordings - this is a stable, reproducible finding, making it more likely to represent either:
- Old anterior MI (loss of septal/anterior forces)
- RV pacing pattern
- LV hypertrophy with clockwise rotation
- Vertical heart in a thin patient
Recommended Next Steps:
- Confirm pacemaker presence / check device records
- If no pacemaker: 2D echocardiogram to assess anterior wall motion and LV function
- Troponin levels if anterior ischemia is clinically suspected
- CHA₂DS₂-VASc score for stroke risk - anticoagulation decision
- Rate control assessment - currently well-controlled; review medications
- Thyroid function tests (TFTs) - mandatory in new or undertreated AF
⚠️ Disclaimer: ECG interpretation provided for clinical decision-support only. Final diagnosis and management must be made by a qualified physician with full clinical context.
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