Case 2

thumb| The ECG

• 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 110 bpm.
  • Conduction (PQ,QRS,QT)
    • PQ-interval=0.16sec (4 small squares), QRS duration=0.10sec, QT interval=320ms
  • Hartaxis
    • Positive in I, II, III, and AVF. Thus a normal heart axis.
  • P wave morphology
    • The p wave is rather large in II, but does not fulfill the criteria for right atrial dilatation.
  • QRS morphology
    • No pathologic Q waves, RsR pattern in V3, but the 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
    • ST depressiion in II,III, and AVF and also in V5-V6. ST-elevation in AVL and V1.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Acuut Anteroseptal Myocardial Infarction