Answer MI 18

Inferior-posterior-lateral myocardial infarction with a nodal escape rhythm - probably due to RCX occlusion

The ECG

• Following the 7+2 steps:
  • Rhythm
    • Regular rhythm with narrow QRS complexes without P waves. Probably a nodal escape rhythm with either atrial standstill or atrial fibrillation with AV block
  • Heart rate
    • 41 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: not applicable QRS: 100ms QT: 450ms QTc: 370ms
  • Heartaxis
    • Negative in I, positive in II and AVF, thus a right axis deviation.
  • P wave morphology
    • No P waves present.
  • QRS morphology
    • Narrow QRS, no pathologic Q waves, normal precordial R wave progression. A notch is seen in the terminal part of the QRS complex in V5/V6.
  • ST morphology
    • ST elevation in I, II, III, AVF, V6. ST depression in AVR, AVL, V1-V5. No ST deviation in V4R
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?