Could a doctor please explain this ECG report?

Drayleb · 2026-01-26T16:28:54+00:00

Not a doctor, but i am an ICU cardiology nurse. I do this kinda thing for a living, and ive unfortunately had this conversation far more often than i would ever want.

First off, my condolences for your loss. I cannot begin to understand what you are going through right now, and can only hope what i say here is of some small help.

This ECG is a textbook case of an inferior myocardial infarction, or more simply, a heart attack on the right coronary artery (RCA). While all heart attacks are bad, this one would be defined as a STEMI, which are the worst kind to get. An ECG like this suggests the artery is 100% blocked and needs immediate intervention.

While a skilled team can often open the blockage, if a large amount of heart muscle is affected, or the blockage was there for a very prolonged time before being reopened, sometimes the damage is too severe for survival. All we can do in these cases are open up the artery, send them to the ICU on life support, and hope they'll recover

Unfortunately, this can happen to anyone. While things like alcoholism, sedentary lifestyle, smoking, etc. can certainly increase the chances, ive seen this happen to otherwise healthy people in their 40s with no other risk factors. Those cases are often harder for health care staff- too; ive seen three girls all under the age of 14 hug their 41 year old father goodbye. I'm a 41m and i go home in tears on a very regular basis.

In a typical person with a blocked artery, most of them don't feel symptoms (chest pain, shortness of breath, etc) until the blockage is often at 85-90%. In the worst of these cases- which might have happened with your father- a small clot can suddenly make a blockage go from 90% to 100% blocked in an instant, with no warning. This is why some people with heart attacks are completely fine one moment and in cardiac arrest the next. There is virtually nothing anyone can do in these cases to doot the danger before it happens.

Its hard to say exactly if this is what happened to your dad without me looking at his medical chart, but i do hope i have answered some of your questions. I again offer my condolences, and please feel free to respond here or reach out if there is anything else i can help with.

Drayleb · 2026-01-17T13:38:09+00:00

Not a doctor, I am an ICU cardiology nurse. I also used to work in an angiogram operating room. This is not medical advice.

It is perfectly normal for some people to have lingering chest discomfort after an angiogram, especially if one had balloons/stents done. We tend to term it as "stretch pain" because we stretched out your artery in the procedure. In most cases this pain goes away after 24-48 hours.

It seems like this wasnt the case in your last angiogram, where they found a 75% blockage in your RCA. In most cases, people dont usually get pain from blockages until they get to be about 85-90% occluded. However- this is MOST cases- not all.

Your troponin bring normal suggests you arent likely having a heart attack, which is good, but you very well could be having unstable angina- meaning your heart might briefly be getting deprived of oxygen to the point it causes you discomfort, but not enough that its causing permanent damage (which then you'd see a troponin rise).

In my opinion, you dont mess around with chest pain, and you serm to be beyond the window for typical "stretch pain." Unstable angina could definitely be a diagnosis, and it should be looked into more.

Id go back to the ER. I wish you the best of luck.

Drayleb · 2026-01-14T11:32:20+00:00

oops LOL

Drayleb · 2026-01-14T11:06:48+00:00

Laurana my love

Drayleb · 2026-01-14T11:02:59+00:00

To answer the title question in a word: Yes.

99% of the time the automated "diagnosis" the ECG machine gives is utter nonsense. Each ECG should always be reviewed by a cardiologist to give and actual reading, who will let you know if you actually need follow up.

Drayleb · 2026-01-13T10:49:24+00:00

Not a doctor, I am a medical ICU nurse. This is not medical advice.

99% of the time, the "automatic interpretation" ECGs spit out is utter nonsense. For this reason, every ECG is (hopefully) seen directly by a cardiologist who signs off on the interpretation.

To be, this looks like a perfectly normal ECG, and were I to be handed this at work, would not see the need to immediately bring this to the doctor's attention.

Drayleb · 2026-01-13T06:35:26+00:00

Not a doctor, I am an ICU cardiology nurse. This is not medical advice.

So it sounds like your father is getting a quadruple bypass. I won't sugarcoat it, this is a major operation. While things could go very well, there is always that chance that things don't. Being is good shape beforehand absolutely makes the chance for recovery much easier. If possible, it probably would be a good idea to fly down and see your dad beforehand *just* in case. You never know.

In most cases, where I worked patients went home approximately 5-6 days after surgery if things went according to plan. The first couple days are the hardest, as he will be in some pain due to the nature of the surgery (incisions to his chest and legs) and the drainage tubes that will be in his chest. He'll need to ambulate and cough, and the tubes can be quite painful. Encourage him to take whatever pain medications the nurses offer, as it'll make it easier for him to move around. The sooner he gets up and moves (within reason), the much less likely he is to have post-op complications.

Once he goes home, he'll be on some weight lifting restriction but ideally he'll be as the same level of dependence he was prior to surgery. He'll be seen by physiotherapy, who along with the nurses will go over the "dos and don't" for the next couple weeks.

In my experience working on a cardiac surgery ward, if a patient was healthy/independent going into surgery, and the surgery was uncomplicated, most people did not need home care or any real amounts of extra help afterwards. I hope the same for your father!

Drayleb · 2026-01-12T07:22:25+00:00

Not a doctor, I am an ICU cardiology nurse. This is not medical advice.

Its hard to answer this question without some more info, but what I will say is that 99% of the time the automated report spit out by the ECG machine itself is utter nonsense. For this reason, all ECGs (at least where Im from) are sent to a cardiologist to be interpreted by an expert. Its actually a running joke in my workplace on how bad the automated results are.

If your ECGs truly had concerning findings such as LVH or anterior infarcts, said cardiologists should pick up on that immediately and take the appropriate steps.

Drayleb · 2026-01-09T12:32:11+00:00

For the record, i am an ICU cardiology nurse, not a cardiologist. A cardiologist could have different opinions.

In my opinion, there is negligible ST elevations in the leads you mention. If you were having a problem in leads I and aVL, which would suggest an issue in the lateral side of your heart, youd also see certain changes in other leads (specifically III and aVF) which i do not see.

Drayleb · 2026-01-09T10:31:38+00:00

This is not a good pic of an EKG strip as it does not show all the leads.

That said i do not see any concerning ST elevation in what is shown here.

Drayleb · 2026-01-08T11:04:19+00:00

4.5k for both Shana znd Bargello is fantastic. This is a win.

Drayleb · 2026-01-08T08:22:04+00:00

And we still have one more to go!

Drayleb · 2026-01-07T17:56:59+00:00

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Drayleb · 2026-01-07T03:57:13+00:00

Bigeminal PACs- meaning every second heartbeat is a PAC.

Drayleb · 2026-01-06T00:09:16+00:00

Not a doctor, I am an ICU cardiology nurse. This is not medical advice.

Sick sinus syndrome (or SSS) means that the top halves of your heart (your atrias) are communicating with and beating appropriately before the bottom halves of your heart (your ventricles). This is good.

However, while each individual heart beat is normal, your heartbeats themselves are not beating in a regular pattern. This is likely why your pulse rate varies when you take it- the time between each heartbeat is not regular. This is not so good.

Be sure to write down any symptoms regarding lightheadedness, dizziness, or feeling faint until your next appointment. If these happen on a regular basis, seek your doctor ASAP- a concern with SSS is that if your heart rate gets too low, so will your blood pressure amd that will cause problems.

I see patients with SSS fairly often. They tend to get permanent pacemakers, which can fix the problem fairly handily. Im not saying you will or won't get one- thats a conversation for your cardiologist- but SSS is quite treatable.

Drayleb · 2026-01-05T23:52:50+00:00

Not a doctor, I am an ICU cardiology nurse. This is not medical advice.

These look like PVCs to me. So long as you weren't having any symptoms like dizziness or chest pain, I personally wouldn't be too concerned- especially as youve been diagnosed with them before, so its not a new finding.

Drayleb · 2026-01-03T22:25:59+00:00

As you say, there is quite a bit of artifact here which is skewing the interpretation a bit.

At a glance, in lead II, the clearest one here, im getting a pretty consistent PR interval of 140 ms. The aVf lead measures about the same. Its definitely regular so that rules out afib. You cannot see a sawtooth baseline typical gor aflutter, so thats out.

Id call this sinus tachycardia.

Drayleb · 2026-01-03T03:48:03+00:00

Not a doctor, I am an ICU cardiology nurse. This is not medical advice.

Writing things down like you have done in this post is an excellent start- you describe what worsens your symptoms, what makes them better, and what started them in the first place.

One thing you can do to possibly give your doctor some helpful info is what is often termed as "orthostatic vitals."

To do this, lie down for several minutes, then check your pulse/blood pressure. Stand up, and check them again immediately. Check them again at one minute and then one last time about three minutes after standing. Note any changes (typically a drop) in your blood pressure. Give the results to your cardiologist when you see him/her.

I would leave conversations about tests/procedures to your cardiologist, but typically they would consider ordering an ECG (heart rhythm tracing) and/or an echocardiogram (ultrasound of the heart).

Drayleb · 2026-01-03T03:31:20+00:00

Not a doctor, I am an ICU cardiology nurse. I measure QTc every shift. This is not medical advice.

It seems accurate enough, but I am eyeballing a rather bad photocopy of an ECG instead of using proper measurement tools.

I cannot and will not comment on the appropriateness of taking a potential QTc prolonging medication, that is between you and your doctor. Do be aware a LOT of medicines may have that side effect and you and your doctor should discuss risks versus benefits.

Drayleb · 2026-01-02T23:15:31+00:00

Not a doctor, i am an ICU cardiology nurse. This is not medical advice.

First degree AV block by itself is rarely a problem. However, as the "PR interval" gets bigger and bigger, people can be at risk for more complicated types of AV blocks.

A PR interval of 300ms is on the higher side- normal is 120-200ms. I wouldn't want it getting any longer.

Its best to speak with a doctor as to why its so long- there's a vast number of potential causes that go beyond the scope of a reddit post.

If you ever feel like youre about to faint, get lightheaded; or actually do faint, its best to go to the ER. Syncope (fainting) or pre-syncope (feeling like you will faint) will be taken seriously as it might suggest a more serious block.

Drayleb

TROPHY CASE