The other most noticeable abnormality on this ECG is the axis shift – normally, Lead II is positive. Interpretation: The fast rate is probably attributable to the patient’s difficulty breathing, as this ECG was obtained in the Emergency Department before treatment had a chance to alleviate his symptoms. There are no pathological Q waves, unless we count V1, which may have lost it’s Q wave as part of the general poor R wave progression. The ST segments are generally concave up, and the J points are at the baseline – no ST elevation or depression. V1 through V4 look almost the same, small r and large S. This is very close to being wide enough for a diagnosis of left bundle branch block, and represents poor conduction throughout the ventricles. On the chest leads side, there is poor R wave progression. AVR is equiphasic – the axis travels perpendicular to the positive electrode of aVR, toward the patient’s left shoulder. Notice that Leads II, III, and aVF are all negative. The frontal plane QRS axis is -56 degrees – abnormally leftward. The PR interval is 155 ms (.15 seconds), and the P waves are upright in the inferior leads. The ECG: The rhythm is sinus at 97 bpm (fast for this patient). We do not have other history available to us.
He had a history of CHF and hypertension. The Patient: This ECG was obtained from an elderly man who was suffering an exacerbation of congestive heart failure.