Answer MI 21

The ECG

• 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
  • Heart rate
    • 90 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: 160ms QRS: 80 ms QT: 340ms QTc: 416ms
  • Heartaxis
    • QRS positive in I and negative in II and AVF: left heart axis deviation
  • P wave morphology
    • P wave positive in II, III and AVF, biphasic in V1. The P waves have normal morphology.
  • QRS morphology
    • Narrow QRS. QS in V1-V2. Q in V4. Reduced R wave progression.
  • ST morphology
    • ST elevation in I, AVL, V1-V5 (V3=V4R and not elevated). ST depression in III and AVF.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Sinusrhythm with anteroseptal infarction. Ischemic vector is pointing upwards (ST depression in AVF), a sign of proximal LAD occlusion.