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Describe this ecg
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Reading File
Here is a full systematic description of this ECG:
ECG Report - HJ Omar, Mohd Sauffi | 52 years | 15/07/2026
Technical Parameters
| Parameter | Value |
|---|---|
| Paper speed | 25 mm/s |
| Gain | 10 mm/mV |
| Frequency response | 0.5-35 Hz |
| Date/Time | 15/07/2026, 08:10:12 |
Measured Intervals (Machine-Reported)
| Interval | Value | Reference |
|---|---|---|
| P/PR | 122 / 168 ms | PR normal (120-200 ms) |
| QRS | 166 ms | Prolonged (normal <120 ms) |
| QT/QTc | 436 / 467 ms | QTc borderline prolonged |
| P/QRS/T axis | 39 / 46 / 22 deg | Normal axis |
| Heart rate | 69 bpm | Normal |
Rhythm
- Sinus rhythm - regular rhythm at 69 bpm with a P wave preceding each QRS at a constant PR interval of 168 ms.
Key Morphological Findings
QRS Complex - Wide (166 ms) - Right Bundle Branch Block (RBBB)
- Lead V1: rsR' pattern ("M-shaped" or "rabbit ear" morphology) - the hallmark of RBBB
- Lead V6 and lateral leads (I, aVL): Wide slurred S waves
- QRS axis is normal (46°), excluding associated left axis deviation
Septal/Anterior Infarct Pattern
- V1-V3: Deep S waves / QS or rS morphology suggestive of anteroseptal myocardial infarction (age indeterminate)
- The machine flags "anteroseptal infarct" - there are likely absent R waves or pathological Q-equivalent changes in V1-V3
- The RBBB makes full infarct assessment more difficult (infarct patterns can be partially masked)
ST-T Changes
- In RBBB, the expected secondary ST-T changes are discordant (ST depression and T-wave inversion in right precordial leads V1-V2 are expected)
- Any primary ST changes (concordant ST elevation) would be more concerning but require direct visual correlation
Machine Interpretation (Printed on ECG)
The automated report states:
"Warning: sex not available; assumed male" Sinus rhythm RBBB (Right Bundle Branch Block) Anteroseptal infarct Consider also periinfarct block Abnormal ECG Unconfirmed Report
Clinical Summary
This is an abnormal ECG showing:
- Sinus rhythm at 69 bpm - normal rate and regularity
- Right Bundle Branch Block (RBBB) - QRS duration 166 ms (significantly prolonged), with characteristic V1 morphology
- Anteroseptal myocardial infarction - likely old/prior infarct with Q-wave/QS changes in V1-V3; age of infarct is indeterminate from the trace alone
- Borderline QTc prolongation - 467 ms (upper limit of normal is ~450 ms in males)
- The machine also suggests "periinfarct block" - a conduction defect at the border zone of the infarcted myocardium contributing to the QRS widening
Clinical Considerations
- New vs. old RBBB? A prior ECG for comparison is important. New RBBB in the context of chest pain would be a STEMI-equivalent requiring urgent intervention.
- Is this an acute event? If the patient is symptomatic, urgent troponin and serial ECGs are warranted. RBBB with anteroseptal infarct pattern and no prior history should be treated as potentially acute until proven otherwise.
- QTc 467 ms - monitor for QT-prolonging medications; consider electrolyte check (K+, Mg2+).
- This ECG is labelled "Unconfirmed Report" - automated interpretation requires physician over-read.
Disclaimer: This is an educational ECG description. Clinical decisions must be made by a qualified clinician who has examined the patient and reviewed the full clinical context.
History of MI
With a known history of MI, the ECG picture becomes much clearer and more reassuring. Here is the updated interpretation:
Updated ECG Interpretation - Known History of MI
What Changes With This History
The anteroseptal infarct pattern (QS/rS morphology in V1-V3) is now almost certainly an old, established finding rather than an acute event. This is the expected residual scar pattern following a prior anteroseptal MI.
Final Interpretation
| Finding | Significance |
|---|---|
| Sinus rhythm, 69 bpm | Normal - stable |
| PR 168 ms | High-normal, not pathological |
| RBBB (QRS 166 ms) | Likely chronic - may have developed at time of original MI or shortly after |
| QS pattern V1-V3 | Old anteroseptal infarct scar - expected with prior MI history |
| QTc 467 ms | Borderline - monitor medications |
| Normal axis | No additional hemiblock |
Pathophysiology Explained
The RBBB + anteroseptal infarct combination is a classic post-MI finding. The LAD (left anterior descending artery) supplies:
- The anterior and septal walls of the left ventricle (hence the Q waves in V1-V3)
- The right bundle branch (hence the RBBB)
A proximal LAD occlusion can damage both simultaneously, producing exactly this pattern - sometimes called "peri-infarct block", which is precisely what the machine flagged.
What to Look For on Follow-Up
Even with a known MI history, be alert to changes from baseline:
- New or worsening ST elevation - could signal re-infarction or LV aneurysm formation
- New T-wave changes - particularly in leads overlying the old infarct territory
- QTc trending up - if on antiarrhythmics, watch for drug-induced QT prolongation
- Symptoms - any chest pain, dyspnea, or syncope warrants serial troponins regardless of the chronic ECG appearance
Clinical Bottom Line
This ECG is consistent with stable, chronic post-MI changes. The RBBB is likely a permanent sequela of the original infarction. No acute ischemic changes are apparent. Routine cardiology follow-up and optimization of secondary prevention medications (aspirin, statin, ACE inhibitor/ARB, beta-blocker) remain the priority.
This is an educational interpretation only. Clinical decisions require physician assessment of the full clinical picture.
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