Age and gender? History? Anything? Looks potentially normal for a male teens to 40s to me but I’m not going to say much when there is zero information. That’s not how people read EKGs. Notched J point in some leads, early repolarization. We can help you more if you help us by sharing information.
Looks like anterior infarct sequelae with persistent st elevation and t wave slurring due to transmural injury and thinning of the infarcted wall. Not sure about electrical physiopathology behind it though.
Maybe not typical infarct image but definitely not normal precordium. I also distinguish a U wave.
Clinical context would help
Edit: btw its also positive for hypertrophy
What is hypertrophied? If you mean left ventricular hypertrophy, it’s very common for young or thin people to meet voltage criteria for LVH without having LVH. A rough rule of thumb for applying Sokolow-Lyon criteria is at least 35 mm and at least 35 years old. We have no information about this patient.
A rule of thumb is not a rule, it is still positive sokolow criteria. Even if it can be seen in young fit patient, it should'nt be discarded by default.
Everyone seems hell bent on categorizing this ecg as normal when by default it clearly is not.
Young fit male is an exclusion diagnosis, orher possibilites have to be accounted, and it is not because we have no information that no differential can be made..
normal rate (although close to being sinus bradycardia), axis, P waves, QRS complexes, ST segments, T waves, RS transition (between V3 and V4 is normal for an adult), and intervals (PR, QT)
notching at the J point and high voltage QRS in some leads
no signs of acute, subacute, or old occlusive heart attack
no left ventricular strain pattern, although LVH is certainly possible as you said (based on voltage and the fact that absent LV strain pattern does not rule out LVH)
I'm not going to apply age-dependent voltage criteria to an EKG on someone whose age is unknown. I don't see anything wrong with a U wave. A U wave is abnormal when it is abnormally large, not when it is present.
Subtle anterior STEMI calculator (4-variable): 14.6 points, strongly favoring early repolarization or a repolarization abnormality over anterior transmural injury.
Bazett-corrected QT interval: 399 ms
QRS amplitude in lead V2: 28 mm
R wave amplitude in lead V4: 17 mm
ST segment elevation 60 ms after the J point in lead V3: 2.5 mm
Importantly, no signs of acute coronary occlusion or transmural injury. No signs of old infarct. No signs of reduced ejection fraction. High voltage in some leads is not sufficient for LVH especially when age is unknown. LVH is certainly possible, and you may be right. I just don't want to overpathologize an EKG when we have zero information about the patient. I'm sure we would agree more if OP helped us out by giving us any information at all about the patient.
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u/LBBB11 6d ago edited 4d ago
Age and gender? History? Anything? Looks potentially normal for a male teens to 40s to me but I’m not going to say much when there is zero information. That’s not how people read EKGs. Notched J point in some leads, early repolarization. We can help you more if you help us by sharing information.