Answer Case 3
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Try to interprete this ECG using the 7+2 step method
- Following the 7+2 steps:
- 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
- 78 bpm
- Conduction (PQ,QRS,QT)
- PQ: 180ms QRS: 160ms QT: 370ms QTc: 420ms
- Negative in III, AVF and AVR, positive QRS complexes in I, II and AVL: horizontal heart axis
- P wave morphology
- The P waves have normal morphology.
- QRS morphology
- Wide QRS complexes with left bundle branch block pattern.
- ST morphology
- ST elevation in V1-V3, AVR. ST depression in I, II, III, AVF, V4-6. The Sgarbossa criteria for ischemia in LBBB are not met (nog concordant ST deviation, no ST depression V1-V3, nog discordant ST elevation > 5 mm).
- Compare with the old ECG (not available, so skip this step)
Sinusrhythm with left bundle branch block, comparison with an old ECG is mandatory to evaluate whether the LBBB is new (a sign of myocardial infarction) or old.