1. Stepwise interpretation of ECG
ID 279

2. 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

3. 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?

4. 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

5. ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement
There are signs of left atrial enlargement

6. 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

7. 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

8. 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

9. There is right ventricular hypertrophy
ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation
Right ventricular hypertrophy

10. There are no QRS signs of myocardial infarction
ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation
Right ventricular hypertrophy

11. 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

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