IMG_20260728_221721.jpg
Interpret this ecg
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Here is a detailed interpretation of this ECG:
ECG Interpretation
Patient: Male, 77 years
Settings: 25 mm/s paper speed, 10 mm/mV gain, 0.5-35 Hz filter
Machine Measurements
| Parameter | Value | Normal Range |
|---|---|---|
| Heart Rate | 50 bpm | 60-100 bpm |
| P duration | 112 ms | <120 ms |
| PR interval | 130 ms | 120-200 ms |
| QRS duration | 88 ms | <120 ms |
| QT / QTc | 456 / 416 ms | QTc <440 ms (men) |
| P/QRS/T axis | 58° / 1° / 44° | Normal |
| RV5/SV1 voltage | 0.943 / 0.604 mV | Low |
Systematic Analysis
Rate: 50 bpm - Sinus bradycardia
Rhythm: Regular. P waves present before every QRS, suggesting sinus origin.
P wave: Duration 112 ms (borderline - approaching but not exceeding 120 ms). Axis 58° is normal.
PR interval: 130 ms - normal (not prolonged).
QRS duration: 88 ms - narrow, rules out bundle branch block.
QRS axis: +1° - this is at the very left edge of normal (normal is 0° to +90°). Borderline left axis deviation.
QTc: 416 ms - within normal limits for a male (borderline, close to 440 ms threshold).
Voltage: RV5 (0.943 mV) + SV1 (0.604 mV) = 1.547 mV - this is below the Sokolow-Lyon criterion for LVH (>3.5 mV), so no voltage criteria for LVH.
Visual findings from the tracing:
- Precordial leads V1-V3: Likely show poor R-wave progression given the morphology, which in a 77-year-old man warrants attention for possible old anterior infarction or COPD-related pattern.
- ST segments and T waves: The T-axis (44°) is concordant with the QRS axis (1°), suggesting no major ST-T abnormality by axis alone. Visual assessment of the tracing shows relatively small-amplitude complexes throughout.
- No obvious ST elevation or depression in limb leads.
Summary / Impression
- Sinus bradycardia (50 bpm) - the most prominent finding. In a 77-year-old, causes include: medications (beta-blockers, digoxin, calcium channel blockers), hypothyroidism, sick sinus syndrome, or athlete's heart (less likely at this age).
- Borderline left axis deviation (QRS axis +1°) - at the edge of normal; consider left anterior fascicular block if axis is truly leftward, inferior MI, or normal variant.
- QTc 416 ms - borderline prolonged for age; worth monitoring especially if starting any QT-prolonging medication.
- No LVH by voltage criteria.
- No definitive acute ischemia visible from available measurements, though clinical correlation is essential.
Clinical note: This ECG should be correlated with the patient's symptoms, medication list, and prior ECGs. The handwritten notes on the paper (partially legible) appear to reference a clinical history - those details would be important for context. A formal cardiologist review is recommended for this 77-year-old patient.
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