Answer Case 4

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Previous ECG: Case 3 | Next ECG: Case 5


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


  • 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.