ECG Interpretation - Mrs. Bhagwati, 50F

Patient Context

• Hospital: District Hospital Rajgarh (Biaora), MP
• Date: 03/07/2026, 10:20 AM
• BP: ~129/60 mmHg
• Department: General Medicine

Key Findings

1. Rate & Rhythm - CRITICAL

• Heart Rate: ~40-52 bpm - This is significant sinus bradycardia
• The second image shows ~7 large squares between QRS complexes (300/7 = ~43 bpm), confirming severe bradycardia
• Rhythm is regular

2. P Waves

• Present and upright before every QRS complex
• Normal morphology - confirms sinus origin

3. PR Interval

• ~140-180 ms - Normal (120-200 ms)
• No evidence of AV block

4. QRS Complex

• Narrow (<120 ms) - normal ventricular conduction
• Normal axis (~41 degrees)

5. ST Segment & T Waves

• V1-V2: Flat to mildly inverted T waves (circled in blue by the clinician) - the highlighted area draws attention to a QS pattern or poor R-wave progression
• V4-V6: Low amplitude T waves
• No acute ST elevation seen

6. Other Automated Flags (from machine printout)

What the Clinician Has Already Done (from handwritten notes)

• Inj. Atropine (1 amp = 0.6 mg) - repeat every 10 minutes if no response (standard protocol for symptomatic bradycardia)
• Referral - noted referral to a higher center / Dr. Ashok

Summary Interpretation

Sinus Bradycardia (~40-45 bpm) in a 50-year-old female, with:

• Borderline LVH voltage criteria
• T-wave changes in V1-V2 (flat/inverted) - possibly a QS pattern raising the question of old septal infarct vs. normal variant
• Inferior/lateral ST-T abnormalities possibly related to hypertrophy or ischemia
• No acute STEMI pattern

Clinical Recommendations

1. Check for symptoms - Is she dizzy, syncopal, hypotensive, or in heart failure? Symptomatic bradycardia requires urgent treatment (already initiated).
2. Troponin + Repeat ECG - The "cannot rule out septal infarct" flag warrants urgent troponin levels to exclude acute/recent MI.
3. Electrolytes - Hyperkalemia and hypothyroidism are reversible causes of sinus bradycardia - check K⁺, TSH.
4. Echocardiogram - To evaluate LVH and wall motion abnormalities if septal infarct is suspected.
5. Cardiology referral - Appropriate given the severity of bradycardia (HR 40-45 bpm); if refractory to atropine, transcutaneous pacing should be considered.
6. Medication review - Rule out drug-induced bradycardia (beta-blockers, calcium channel blockers, digoxin).

⚠️ Disclaimer: This interpretation is for educational/clinical support only and must be correlated with the patient's clinical presentation by the treating physician. Automated ECG readings have significant false-positive rates and should never replace clinical judgment.