Answer MI 14: Difference between revisions

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(New page: ===Answers=== * Describe the ECG according to the 7 + 2 stepplan **Rhythm ***'''This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II, III a...)
 
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===Answers===
{{Case|
|previouspage= MI 13
|previousname= MI 13
|nextpage=MI 15
|nextname=MI 15
}}
'''Where is this myocardial infarction located?'''
 
[[Image:Casus2_2.jpg|700px|thumb|left|ECG MI 14. Click on image for enlargement.]]
[[Image:Casus2_1.jpg|700px|thumb|left|ECG MI 14. Note that V3-V6 are on the right side of the chest. Click on image for enlargement.]]
{{clr}}
===Answer===


* Describe the ECG according to the 7 + 2 stepplan
* Describe the ECG according to the 7 + 2 stepplan
Line 5: Line 16:
***'''This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II, III and AVF and originates form the sinusnode. Conclusion: sinusrhythm.'''
***'''This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II, III and AVF and originates form the sinusnode. Conclusion: sinusrhythm.'''
**Heartfrequency.  
**Heartfrequency.  
***'''Use the 'telmethode' (6 grote hokjes ~> 300-150-100-75-60-50), dus 50/min.'''
***'''Use the 'Countingmethod' (6 big grids ~> 300-150-100-75-60-50), so 50/min.'''
**Geleidingstijden (PQ,QRS,QT)  
**Conductiontimes (PQ,QRS,QT)  
***'''PQ-tijd=0.16sec (4 kleine hokjes), QRS duur=0.10sec, QT tijd=460ms'''
***'''PQ-interval=0.16sec (4 small grids), QRS duration=0.10sec, QT time=460ms'''
**Hartas
**Heartaxis
***'''Positief in I, iso-electrisch in II, negatief in III en AVF. Dus een linker hartas.'''
***'''Positive in I, iso-electric in II, negative in III and AVF. So, a left axis.'''
**P top morfologie
**P wave morphology
***'''De p top is normaal van vorm.'''
***'''The p wave is normal shaped.'''
**QRS morfologie
**QRS morphology
***'''Geleidingsvertraging rechts, maar te weinig voor een rechterbundeltakblok (QRS < 0.12s). Trage r-top progressie over de voorwand.'''
***'''Conduction delay right, but not enough for the complete RBBB criteria (QRS < 0.12s). Slow R-wave progression in the precordial leads.'''
**ST morfologie
**ST morphology
***'''Forse ST elevatie in II,III en AVF. Reciproke depressies in I, AVR en AVL met negatieve T toppen aldaar. Ook enige elevatie in V2-V5. Ook ST-elevatie in V4R (rechts uitgepoold en kijkt dus naar de rechter ventrikel)'''
***'''ST elevation in II,III and AVF. Reciprocal depression in I, AVR and AVL with negative T waves. Additionally discrete elevation in V2-V5. And ST-elevation in V4R'''
**vergelijking met het oude ECG (niet voor handen, dus overslaan)
**Compare with the old ECG (not available)
**conclusie. Wat is er aan de hand?
**conclusion. What is going on?
 
 
'''Antwoord: Onderwandinfarct met rechterventrikeluitbreiding en daarnaast:
* Sinusbradycardie doordat waarschijnlijk de sinusknooptak, een afsplitsing van de rechter coronair-arterie niet goed doorbloed wordt.
* Linker hartas


[[Afbeelding:Casus2_2.jpg|thumb|300px|left| het ECG]]
'''Answer: Inferior wall infarct with right ventricular involvement and:
{{clr}}
* Sinusbradycardia, probably because the sinusnodebranch, coming from the RCA is lacking perfusion.
[[Afbeelding:Casus2_1.jpg|thumb|300px|left| Dit is rechtsuitdraai]]
* Left heart axis
{{clr}}

Latest revision as of 11:08, 11 November 2008

This page is part of Cases and Examples

Previous ECG: MI 13 | Next ECG: MI 15

Where is this myocardial infarction located?

ECG MI 14. Click on image for enlargement.
ECG MI 14. Note that V3-V6 are on the right side of the chest. Click on image for enlargement.


Answer

  • Describe the ECG according to the 7 + 2 stepplan
    • Rhythm
      • This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II, III and AVF and originates form the sinusnode. Conclusion: sinusrhythm.
    • Heartfrequency.
      • Use the 'Countingmethod' (6 big grids ~> 300-150-100-75-60-50), so 50/min.
    • Conductiontimes (PQ,QRS,QT)
      • PQ-interval=0.16sec (4 small grids), QRS duration=0.10sec, QT time=460ms
    • Heartaxis
      • Positive in I, iso-electric in II, negative in III and AVF. So, a left axis.
    • P wave morphology
      • The p wave is normal shaped.
    • QRS morphology
      • Conduction delay right, but not enough for the complete RBBB criteria (QRS < 0.12s). Slow R-wave progression in the precordial leads.
    • ST morphology
      • ST elevation in II,III and AVF. Reciprocal depression in I, AVR and AVL with negative T waves. Additionally discrete elevation in V2-V5. And ST-elevation in V4R
    • Compare with the old ECG (not available)
    • conclusion. What is going on?

Answer: Inferior wall infarct with right ventricular involvement and:

  • Sinusbradycardia, probably because the sinusnodebranch, coming from the RCA is lacking perfusion.
  • Left heart axis
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