Answer Case 4

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The ECG

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

Answer

• Following the 7+2 steps:
  • Rhythm
    • The ECG starts with a regular rhythm with normal P waves (positive in I, III and AVF, negative in AVR), followed by QRS complexes. Sinusrhythm
  • Heart rate
    • around 60 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: 240ms QRS: 120ms QT: 440ms QTc: same as QT at this heart rate
  • Heartaxis
    • Negative in II, III and AVF: left heart axis
  • P wave morphology
    • The P wave duration is somewhat prolonged.
  • QRS morphology
    • Wide QRS complexes with [[[RBBB|right bundle branch block]]] pattern. No LVH or pathologic Q waves.
  • ST morphology
    • ST depression in V1. Overall flat ST segments.
  • 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.