Stepwise interpretation of ECG

ID 279

ID 279 – This 57 year old woman who had rheumatic fever at age 17 has been suffering from severe dyspnea and fatigue during the past year

ID 279 – This 57 year old woman who had rheumatic fever at age 17 has been suffering from severe dyspnea and fatigue during the past year

Do you see P waves?

ID 279 – Normal sinus rhythm, 80/min

Yes: The P waves originate from the sinus node– The rhythm is regular , the rate is 80/min.– Each P is followed by a QRS - The PR interval is normal – NORMAL SINUS RHYTHM, 80/min

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement

There are signs of left atrial enlargement

Let’s now look at the QRS complexes: There is Right axis deviation

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation

Let’s now look at the QRS complexes: There is Right axis deviation

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation

The QRS duration is normal : There is no right bundle branch block, left bundle branch block or non-specific block

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation

There is right ventricular hypertrophy

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy

There are no QRS signs of myocardial infarction

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy

There is ST depression with negative T waves in II, III, aVF and the right chest leads (V1-V3), that may be due to RVH – There are also negative T waves in V4-V6. Diffuse T changes are not uncommon in patients who are in heart failure. They may be due to ischemia

ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy

ID 279 – Final diagnosis: Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy with ST-T abnormalities