🔷 ECG Parameters (from the strip header)

STEP 1 - RATE

STEP 2 - RHYTHM

• Regular rhythm - R-R intervals are consistent throughout all leads
• P wave present before every QRS - Sinus origin confirmed
• Conclusion: Normal Sinus Rhythm ✓ (Machine is correct here)

STEP 3 - AXIS

• QRS Axis = +28° - Normal axis (normal range: -30° to +90°)
• P axis = 48° - Normal
• T axis = 121° - This is the KEY abnormality

⚠️ QRS-T angle = 121° - 28° = 93° - This is WIDE (normally <45°). A wide QRS-T angle is a marker of repolarization abnormality (strain or ischemia).

STEP 4 - P WAVE ANALYSIS

• P wave duration ~102 ms - Normal (<120 ms)
• P (II) amplitude = 0.13 mV - Normal
• P wave morphology: upright in I, II, aVF - confirms sinus rhythm
• No bifid or peaked P waves visible

STEP 5 - PR INTERVAL

• 168 ms - Normal (120-200 ms)
• No first, second, or third-degree AV block

STEP 6 - QRS COMPLEX

• Duration 82 ms - Normal (<120 ms), so no bundle branch block
• Morphology:
  • Lead I: Small R wave, visible S wave - slightly low voltage
  • Lead II: Upright QRS, reasonable amplitude
  • Lead III: Small QRS complexes
  • aVR: Predominantly negative (normal)
  • aVL: Low amplitude
  • V1: rS pattern (normal)
  • V2: Transitional
  • V4-V6: R-wave progression present
  • Sokolow-Lyon index (S(V1) + R(V5)) = R(V5) 1.74 mV - Sokolov total 2.67 mV - just below the traditional LVH threshold of 3.5 mV, but borderline

STEP 7 - ST SEGMENT ANALYSIS ⚠️ (Most Important)

Leads I and aVL (High Lateral):

• ST changes visible in I and aVL
• Flattening or possible subtle ST depression in Lead I and aVL
• These leads look at the high lateral wall (supplied by diagonal branch of LAD or circumflex)

Inferior Leads (II, III, aVF):

• ST segment appears isoelectric with no significant elevation
• No acute inferior STEMI pattern

Precordial Leads (V1-V6):

• V1-V2: No significant ST elevation
• V4-V6: ST segments appear relatively flat, possible minimal depression in V5-V6

Key Manual Observation:

The machine flagged "High Lateral Ischemia OR LV Strain" - manual review supports this:

• ST-T changes in I/aVL = high lateral territory
• Wide QRS-T axis angle + borderline voltage = LV strain pattern cannot be excluded

STEP 8 - T WAVE ANALYSIS ⚠️

• T axis = 121° - Abnormal (should be within 45° of QRS axis of 28°)
• T wave inversions or flattening likely in Leads I and/or aVL (high lateral)
• T waves in V1-V3 appear upright (normal)
• T waves in inferior leads appear positive (no inferior ischemia pattern)
• The discordant T axis is the most objective marker of repolarization pathology

STEP 9 - QT / QTc

• QT = 354 ms, QTc = 432 ms
• In a 62-year-old female: upper limit of normal is ~460 ms for women
• QTc is normal - no prolonged QT

STEP 10 - OVERALL INTERPRETATION (Manual)

📋 CLINICAL BOTTOM LINE

1. "ST & T Abnormality - High Lateral Ischemia or LV Strain" - Manual reading agrees with this concern
2. However, the machine did NOT adequately flag the wide QRS-T axis angle (93°) as an independent repolarization marker
3. The borderline Sokolov voltage + T axis discordance together suggest LV strain (as seen in hypertensive heart disease, LVH) is the more likely explanation in a 62F, rather than acute ischemia - unless the patient has chest pain or other acute symptoms

What to do next (clinically):

• Compare with old ECG - if ST-T changes are new, urgent workup needed
• Troponin levels - rule out NSTEMI
• Echo - assess LV wall motion and hypertrophy
• BP check - hypertensive LV strain is common in this demographic

⚠️ This is an unconfirmed machine report (as stated on the ECG). A qualified cardiologist must review the original tracing before any clinical decision.