Answer Case 4: Difference between revisions

Answer Case 4 (view source)

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 * Following the 7+2 steps:
 **Rhythm
-***'''The ECG shows a regular rhythm with normal P waves (positive in I, III and AVF, negative in AVR), followed by QRS complexes. Sinusrhythm'''
+***'''The ECG shows a regular rhythm, but the last couple of beats are faster. Between these last beats clear P waves are discernable. De distance between the P waves and QRS complexes changes and there seems to be no relation between the two: [[AV dissociation]]. As there are no P waves preceding the first QRS complexes the rhythm must be of [[Nodal Rhythm|nodal origin]] in competition with [[sinusrhythm]]. The 10th, 12th and 13th beats are preced by a P wave, here the sinusrhythm has taken over from the nodal rhythm.'''
 **Heart rate
-***'''around 60 bpm'''
+***'''around 80 bpm'''
 **Conduction (PQ,QRS,QT)
-***'''PQ: 240ms QRS: 120ms QT: 440ms QTc: same as QT at this heart rate
+***'''PQ: not applicable. QRS: 110ms QT: 380ms
 **Heartaxis
-***'''Negative in II, III and AVF: left heart axis'''
+***'''Positive in I and II, negative in III. Slightly positive in AVF. An intermediate heart axis.'''
 **P wave morphology
-***'''The P wave duration is somewhat prolonged.'''
+***'''The P waves that are present seem to have a normal morphology.'''
 **QRS morphology
-***'''Wide QRS complexes with [[[RBBB|right bundle branch block]]] pattern. No LVH or pathologic Q waves.'''
+***'''Slightly broad QRS complexes. QS in V1.'''
 **ST morphology
-***'''ST depression in V1. Overall flat ST segments.'''
+***'''Negative T in III oreceded by a negative QRS complex (normal).'''
 **Compare with the old ECG (not available, so skip this step)
 **Conclusion?
-'''Trifascicular block with first degree AV block, right bundle branch block and left anterior fascicular block.'''
+'''Nodal rhythm in competition with sinusrhythm.'''
 {{clr}}