ecg interpretation
Reading File
Finding Sources
Finding Sources
I have a clear view of the ECG. Let me now provide a thorough interpretation based on the visible data.
ECG Interpretation
Machine Header Data (from the printout):
- Date/Time: 15/05/26, 19:36
- Facility: Krishna Hospital, Dep: HDU
- HR: 106 bpm
- Speed: 25 mm/s | Gain: 10 mm/mV
- Axes (deg): P: 58, QRS: 24, T: 0
- Intervals (msec): PR: 119, QRS: 104, QT: 423, QTc: 564, ST: 106
Systematic Analysis
1. Rate
106 bpm — Sinus tachycardia
2. Rhythm
Regular. P waves precede every QRS. Normal sinus rhythm with tachycardia.
3. Axis
- P-axis: 58° — Normal
- QRS axis: 24° — Normal (no axis deviation)
4. Intervals
| Parameter | Value | Interpretation |
|---|---|---|
| PR | 119 ms | Normal (120–200 ms borderline; this is low-normal/borderline short) |
| QRS | 104 ms | Borderline prolonged (≥120 ms = LBBB/RBBB; 100–120 ms = incomplete bundle branch block) |
| QT | 423 ms | Prolonged in absolute terms at this HR |
| QTc | 564 ms | ⚠️ Significantly prolonged (normal <440 ms men, <460 ms women; >500 ms = high torsades risk) |
5. Waveform Analysis (visual from ECG)
P waves: Upright in I, II, aVF — normal morphology and axis ✓
QRS complex:
- Leads I, II, aVL: Narrow to borderline
- V1: rSR' or slurred upstroke pattern (cannot fully exclude incomplete RBBB)
- V3–V6: Normal progression of R waves visible
- QRS duration ~104 ms — incomplete bundle branch block pattern
ST segments & T waves:
- V1–V3: Possible subtle ST changes (image quality limits precise assessment)
- No obvious ST elevation seen in inferior (II, III, aVF) or lateral leads
- T waves: Cannot fully characterize polarity in all leads from image angle
QT/QTc:
- QTc 564 ms is critically prolonged — this is the most clinically significant finding
⚠️ Critical Finding: Markedly Prolonged QTc (564 ms)
A QTc of 564 ms significantly exceeds the threshold of concern (>500 ms) and places this patient at high risk for Torsades de Pointes (TdP), a potentially fatal ventricular arrhythmia.
Urgent considerations:
Causes to rule out:
| Category | Examples |
|---|---|
| Drugs (most common) | Antipsychotics (haloperidol, quetiapine), antiarrhythmics (amiodarone, sotalol), antibiotics (azithromycin, fluoroquinolones), antiemetics (ondansetron, metoclopramide) |
| Electrolytes | Hypokalemia, hypomagnesemia, hypocalcemia |
| Structural/Ischemic | Myocarditis, acute MI |
| Congenital | Long QT syndrome (LQTS types 1–3) |
| CNS | Intracranial hemorrhage, stroke |
Immediate management:
- Review all medications — stop any QT-prolonging drug
- Check electrolytes STAT — K⁺, Mg²⁺, Ca²⁺; correct aggressively
- IV Magnesium sulfate (2g IV) if symptomatic or QTc >500 ms
- Continuous cardiac monitoring — watch for TdP (polymorphic VT)
- Avoid further QT-prolonging agents
Summary Interpretation
| Finding | Value |
|---|---|
| Rhythm | Sinus tachycardia |
| Rate | 106 bpm |
| Axis | Normal (QRS +24°) |
| PR interval | 119 ms (low-normal) |
| QRS | 104 ms (borderline, possible incomplete BBB) |
| QTc | 564 ms — CRITICALLY PROLONGED |
| ST changes | No definitive STEMI pattern visible |
Primary diagnosis on this ECG: Sinus tachycardia with markedly prolonged QTc (564 ms) — requires urgent evaluation and management.
⚕️ Clinical note: This ECG is from an HDU patient. The combination of sinus tachycardia + QTc 564 ms requires urgent clinical correlation, medication review, and electrolyte correction. This does not replace formal cardiologist review.
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