Answer MI 19

The ECG

• Following the 7+2 steps:
  • Rhythm
    • Regular rhythm with normal P waves (positive in I, II, negative in AVR), followed by QRS complexes. Sinusrhythm
  • Heart rate
    • 46 bpm. Thus sinusbradycardia
  • Conduction (PQ,QRS,QT)
    • PQ: 170ms QRS: 110ms QT: 420ms QTc: 370ms
  • Heartaxis
    • Positive in I and AVL: normal heart axis
  • P wave morphology
    • P wave positive in II, bifasic in V1. Not well discernible in AVF. Seems normal.
  • QRS morphology
    • Pathologic Q waves in III and AVF. Slow R wave progression. Some aspecific intraventricular conduction delays (QRS 110ms).
  • ST morphology
    • ST elevation in II, III (III>II), AVF, V5 (1 mm elevation V4 and V6). ST depression in I and AVL. Lead V3 shows V4R and is not elevated.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Inferior myocardial infarction with Q waves in the inferior leads; probably due to RCA occlusion (III>II, depression in I)