ECG #8

ECG #8

[expand title=”Interpretation”]



Atrial = 57 min-1

Ventricular = 57 min-1


Sinus rhythm

P waves:  

Duration = 60 ms

Amplitude = 0.05 mV

PR interval:

Duration = 140 ms

Morphology = normal

QRS complex:

Duration = 108 ms

Axis = -95°

Q Waves:


R wave progression:


LV Hypertrophy [Sokolow; SV1 + (RV5 or RV6) > 35mm) or RI + SIII > 25mm]?


RV Hypertrophy [R/S ratio V5 or V6 < 1 or R/S ratio V1 > 1 or S1S2S3 pattern]?


ST segments:

Duration = 160 ms

Morphology = sagging downsloping in I, aVL, V2

T waves:

Duration = 160 ms

Morphology = upright aVR; inversion I, aVL, V2-6

QT interval:

QT duration = 458 ms

QTc duration = 445 ms

Additional comments:


Interpretation: This requires a very careful review. The P waves in I and aVL are inverted, but positive in aVR. This suggests that either the left and right arm electrodes are misplaced, or that the spread of atrial depolarisation is reversed. The precordial leads are abnormal. The P waves are small. There is a partial RBBB. The R waves get progressively smaller and there is T wave inversion in all leads except V1. The combination of the limb lead abnormalities and the precordial abnormalities suggest that depolarisation is left to right rather than right to left. These are the classical ECG changes observed in dextrocardia.



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