Example 11

Sinustachycardia with anteroseptal infarction.

The ECG

• Following the 7+2 steps:
  • Rhythm
    • The ECG shows a regular rhythm with normal P waves (positive in II, III and AVF, negative in AVR), all followed by QRS complexes. Sinusrhythm
  • Heart rate
    • About 100 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: 160ms QRS: 80ms QT: 340ms QTc: 439ms
  • Heartaxis
    • QRS positive in I and AVF: normal heart axis
  • P wave morphology
    • Tall P waves in II, but no more than 2.5mm. Otherwise normal P wave morphology.
  • QRS morphology
    • Narrow QRS. No pathologic Q waves. Slow R wave progreesion. (However, lead V3 is probably at position V4R)
  • ST morphology
    • ST elevation in V2. Some ST elevation in leads I and AVL. Some ST depression in V6. Lead V3 again shows V4R which is not elevated.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?