ECG Diagnosis - Mr. Baskaran, 68M

Measured Parameters

Machine Interpretation (MAC600 12SL)

1. Normal Sinus Rhythm - rate 76 bpm, PR 178 ms, regular P waves
2. Possible Left Atrial Enlargement - P duration 114 ms, likely biphasic P in V1 with negative terminal deflection
3. Left Ventricular Hypertrophy (LVH) with repolarization abnormality - high voltage in precordial leads + secondary ST-T changes (strain pattern)
4. Prolonged QT - QTc 510 ms (significantly above the threshold of 450 ms in males)

Clinical Interpretation

• LVH with strain pattern - the most clinically significant structural finding; commonly caused by longstanding hypertension, aortic stenosis, or hypertrophic cardiomyopathy
• Left atrial enlargement - a downstream consequence of LVH / elevated left ventricular filling pressures; raises the risk of atrial fibrillation
• Markedly prolonged QTc (510 ms) - this is a HIGH-RISK finding warranting urgent attention. A QTc >500 ms significantly increases the risk of Torsades de Pointes (TdP) and sudden cardiac death

• Review of all current medications for QT-prolonging drugs (antiarrhythmics, macrolides, fluoroquinolones, antipsychotics, methadone, etc.)
• Serum electrolytes - correct hypokalemia, hypomagnesemia, hypocalcemia
• Thyroid function tests
• Rule out bradycardia-dependent QT prolongation
• Cardiology referral

Summary

Abnormal ECG - Normal sinus rhythm with Left Ventricular Hypertrophy + repolarization strain, Left Atrial Enlargement, and critically prolonged QTc (510 ms). The QT prolongation in particular needs urgent clinical correlation and investigation to exclude a reversible cause or channelopathy risk.