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* Describe the ECG according the 7 + 2 step plan | * Describe the ECG according the 7 + 2 step plan | ||
**Rhythm | **Rhythm | ||
***'''This is a regular rhythm and every QRS complex has a P-wave in front of it. | ***'''This is a regular rhythm and every QRS complex has a P-wave in front of it. The P wave us positive in II, III and AVF and comes from the sinusnode. So it's a sinusrhythm.''' | ||
** | **Heartrate. | ||
***''' | ***'''Use the 'counting methode' (3 large grids ~> 300-150-100), so 100/min.''' | ||
** | **Conductiontimes (PQ,QRS,QT) | ||
***'''PQ- | ***'''PQ-time=0.16sec (4 small grids), QRS duration=0.10sec, QT time=280ms, QTc interval=361 ms''' | ||
** | **Heart axis | ||
***''' | ***'''Isoelectric in I, positive in II, III and AVF. Therefore it is a vertical heartaxis.''' | ||
**P | **P wave morphology | ||
***''' | ***'''The p wave is possibly > 2,5 mm in II (hard to see, a good millimetergrid is lacking), so there could be right atrium overload.''' | ||
**QRS | **QRS morphology | ||
***''' | ***'''Pathologic Q in AVL, V1-V3 and possibly V4-5 (poor quality). Hardly any precordial R-wave progression.''' | ||
**ST | **ST morphology | ||
***''' | ***'''ST elevation in V2-V5 and in I,AVL.''' | ||
** | **No prior ECG to compare | ||
** | **Conclusion. What's going on? | ||
''' | '''Answer: A large anterior wall infraction | ||
Additions: and possibly right atriumoverload caused by backwardfailure of the left ventricle. | |||
[[Image:casus1_1.jpg|thumb|left| ECG | [[Image:casus1_1.jpg|thumb|left| ECG on admission]] | ||
{{clr}} | {{clr}} | ||
[[Continue example 1]] | [[Continue example 1]] |