Case 100

Look at the consecutive ECGs in this patient. What is the problem? thumb|300px|left| ECG1
thumb|300px|left| ECG2
thumb|300px|left| ECG3
thumb|300px|left| ECG4

• Following the 7+2 steps:
  • Rhythm
    • The ECG shows a regular rhythm. Every P wave is followed by a QRS complex. P waves are positive in I and AVF. Normal sinus rhythm
  • Heart rate
    • 40 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: 160ms QRS: 90ms QT: 420ms QTc: 360ms
  • Heartaxis
    • QRS positive in I and AVF: normal heart axis
  • P wave morphology
    • Normal P wave morphology
  • QRS morphology
    • Pathologic Q waves in III and AVF. QS in V1 and V2. No ST elevation in V3 (=V4R).
  • ST morphology
    • ST elevation in II, III, AVF and V5. ST depression in I, AVL.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

sinusbradycardia with inferior-lateral myocardial infarction.