The Patient: This ECG was obtained from an elderly man who was suffering an exacerbation of congestive heart failure. He had a history of CHF and hypertension. We do not have other history available to us.
The ECG: The rhythm is sinus at 97 bpm (fast for this patient). It is regular with no ectopy. The PR interval is 155 ms (.15 seconds), and the P waves are upright in the inferior leads. The frontal plane QRS axis is -56 degrees – abnormally leftward. Notice that Leads II, III, and aVF are all negative. AVR is equiphasic – the axis travels perpendicular to the positive electrode of aVR, toward the patient’s left shoulder. The QRS duration is 111 ms (.11 sec.). 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. V1 through V4 look almost the same, small r and large S.
The ST segments are generally concave up, and the J points are at the baseline – no ST elevation or depression. 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.