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Interpret this ecg

Reading File
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ECG Interpretation

Machine-Reported Data (from the printout)

ParameterValue
Date/Time20-05-2026, 06:01 PM
Heart Rate (HR)94 bpm
P interval70 ms
PR interval119 ms
QRS duration87 ms
QT / QTc (Bazett)412 / 445 ms
P/QRS/T axis15 / 31 / 21
RV5 / SV10.82 / 40.975 mV
Machine DiagnosisSinus Arrhythmia + T Wave Abnormality (V3/V4)

Manual Interpretation

1. Rhythm — Sinus Arrhythmia

The tracing shows sinus rhythm (upright P waves in leads I, II, aVF preceding every QRS). The machine flags sinus arrhythmia, meaning the P-P interval varies by >120 ms or >10% between beats. This is physiologically normal, especially in younger individuals with higher vagal tone — it is the most common "arrhythmia" and requires no treatment. It often fluctuates with respiration (respiratory sinus arrhythmia). — Braunwald's Heart Disease, p. 574

2. Rate

94 bpm — normal sinus rate (60–100 bpm), no bradycardia or tachycardia.

3. PR interval — 119 ms

Borderline short but still within normal range (120–200 ms). No pre-excitation pattern is evident from the tracing.

4. QRS — 87 ms

Normal duration (<120 ms). No bundle branch block. Axis at 31° — normal axis.

5. QTc — 445 ms

Borderline prolonged (normal <440 ms in males, <450 ms in females). Mild prolongation at this level has uncertain clinical significance on its own, but warrants correlation with medications (QT-prolonging drugs), electrolytes (K⁺, Mg²⁺, Ca²⁺), and the clinical context.

6. T Wave Abnormality in V3/V4 ⚠️

This is the most clinically significant finding. T wave changes in the anterior precordial leads (V3/V4) have a broad differential:
CauseFeatures to Note
Ischemia / LAD stenosisDeep (>2 mm), symmetric T-wave inversions in anterior leads are strongly associated with significant proximal LAD stenosis ("Wellens pattern") — Goldman-Cecil Medicine
NSTEMI / Subendocardial infarctionAnterior T-wave inversion ± elevated troponin — Rosen's Emergency Medicine
Right ventricular strain (PE, cor pulmonale)T-wave inversions V1–V4 + S1Q3T3
ARVC (Arrhythmogenic RV Cardiomyopathy)Anterior T-wave inversions + epsilon wave, associated with palpitations/syncope — Tintinalli's
Hypertrophic cardiomyopathyGiant T-wave inversions (especially apical HCM) — Goldman-Cecil
Normal variant / early repolarizationT-wave changes without structural pathology
Post-tachycardia / memory changesBenign T-wave changes after rate changes
From the ECG image itself, the T waves in V3/V4 appear to show flattening or inversion, consistent with the machine annotation. The depth and symmetry cannot be precisely quantified from the photo, but this finding should not be dismissed.

Clinical Recommendation

⚠️ The T wave abnormality in V3/V4 requires clinical correlation. This finding is NOT benign until ischemia has been excluded.
Immediate steps to consider:
  1. Troponin I/T (serial, 0h and 3h or 0h and 1h high-sensitivity) — to rule out ACS/NSTEMI
  2. Clinical history — chest pain, dyspnea, risk factors (HTN, DM, smoking, family history), age and sex of the patient
  3. Compare with prior ECG — new vs. old changes matter greatly
  4. Electrolytes — K⁺, Mg²⁺, Ca²⁺ for QTc borderline prolongation
  5. Echocardiogram — if ischemia suspected, to look for wall motion abnormality of the anterior wall (LAD territory)
  6. Review medications — any QT-prolonging drugs?
The sinus arrhythmia alone is benign and needs no treatment. The T wave abnormality is the flag that needs follow-up.
Sources: Braunwald's Heart Disease, p. 574; Goldman-Cecil Medicine; Rosen's Emergency Medicine; Tintinalli's Emergency Medicine
Disclaimer: This interpretation is for educational/clinical support purposes. A qualified physician must review the original tracing and clinical context before making any management decision.
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