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help in ecg interpretation please

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hi, i'm a student and i've been trying to figure out this ecg but its just making me more confused..


the background is:

elderly female presents with grade 3 pitting edema bilateral lower limbs

sob on exertion

electrolytes normal

trop t elevated (21.4)

NT-proBNP elevated (763)


what i've got so far is:



p wave - normal

qrs - normal

t wave - 'flatten'

left axis deviation


the "model" answer that i'm told is that its IHD with CCF.

but i can't explain the deep s wave in II, III, aVF

as well as the RSR' in V2


any assistance is greatly appreciated


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Do you know the "short-cuts" to determine axis (without looking at the EKG machine printed values) and LAHB? Also look at your QTc interval (you can use the machine's value for this). While borderline for a female, it is something to also pay attention to.

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Since OP hasn't responsed I thought I'd post this for others in case they weren't aware. Normal axis if leads I and AVF are both upright (R>S). LAD if lead I is upright and AVF is downward. RAD if both are downward. With regard to LAHB; If LAD is present and lead II is downward then by default you have a LAHB.

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