Answer MI 16

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Where is this myocardial infarction located?

ECG MI 16. Click on image for enlargement.

Answer

• Following the 7+2 steps:
  • 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 thus originates from the sinus node. Conclusion: sinus rhythm.
  • Hartfrequency
    • Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 90 bpm.
  • Conduction (PQ,QRS,QT)
    • PQ-interval=0.16sec (4 small squares), QRS duration=0.10sec, QT interval=360ms
  • Hartaxis
    • Positive in I, II, III, and AVF. Thus a normal heart axis.
  • P wave morphology
    • The p wave is difficult to assess, because of the (electrical) interference, but does not seem fulfill the criteria for left or right atrial dilatation.
  • QRS morphology
    • No pathologic Q waves. QRS duration < 0.12 seconds thus no bundle branch block is present. No left ventricular hypertrofy: S in V1 + R in V5 < 35mm.
  • ST morphology
    • Evident ST elevation in II,III, and AVF and also in V5. ST-depression in AVL and V1-V2.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Acuut Inferior-Posterior Myocardial Infarction