Answer Case 2

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The ECG

Try to interprete this ECG using the 7+2 step method

Answer

• Following the 7+2 steps:
  • Rhythm
    • This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II,III, and AVF and thus originates from the sinus node. Conclusion: sinus rhythm.
  • Hartfrequency
    • Use the 'count the squares' method (a bit less than 3 large squares ~> 300-150-100), thus about 110 bpm and thus sinustachycardia.
  • Conduction (PQ,QRS,QT)
    • PQ-interval=0.10sec (2.5 small squares), QRS duration=0.10sec, QT interval=320ms
  • Hartaxis
    • Positive in I, II, negative in III and AVF. Thus a horizontal (normal) heart axis.
  • P wave morphology
    • The p wave is rather large in II, but does not fulfill the criteria for right atrial dilatation.
  • QRS morphology
    • The QRS shows a slurred upstroke or delta wave.
  • ST morphology
    • Negative T wave in I and AVF. Flat ST in V3-V5.
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Sinustachycardia] in a patient with a WPW pattern