Answer Case 4: Difference between revisions

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Try to interprete this ECG using the 7+2 step method
Try to interprete this ECG using the 7+2 step method
==Answer==
==Answer==
* Following the 7+2 steps:
* Following the 7+2 steps:
**Rhythm
**Rhythm
***'''The ECG shows a regular rhythm, but the last couple of beats are faster. Between these last beats clear P waves are discernable. De distance between the P waves and QRS complexes changes and there seems to be no relation between the two: [[AV dissociation]]. As there are no P waves preceding the first QRS complexes the rhythm must be of [[Nodal Rhythm|nodal origin]] in competition with [[sinusrhythm]]. The 10th, 12th and 13th beats are preced by a P wave, here the sinusrhythm has taken over from the nodal 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
**Heart rate
***'''around 80 bpm'''
***'''around 60 bpm'''
**Conduction (PQ,QRS,QT)  
**Conduction (PQ,QRS,QT)  
***'''PQ: not applicable. QRS: 110ms QT: 380ms
***'''PQ: 240ms QRS: 120ms QT: 440ms QTc: same as QT at this heart rate
**Heartaxis
**Heartaxis
***'''Positive in I and II, negative in III. Slightly positive in AVF. An intermediate heart axis.'''
***'''Negative in II, III and AVF: left heart axis'''
**P wave morphology
**P wave morphology
***'''The P waves that are present seem to have a normal morphology.'''
***'''The P wave duration is somewhat prolonged.'''
**QRS morphology
**QRS morphology
***'''Slightly broad QRS complexes. QS in V1.'''
***'''Wide QRS complexes with [[[RBBB|right bundle branch block]]] pattern. No LVH or pathologic Q waves.'''
**ST morphology
**ST morphology
***'''Negative T in III oreceded by a negative QRS complex (normal).'''
***'''ST depression in V1. Overall flat ST segments.'''
**Compare with the old ECG (not available, so skip this step)
**Compare with the old ECG (not available, so skip this step)
**Conclusion?
**Conclusion?




'''Nodal rhythm in competition with sinusrhythm.'''
'''Trifascicular block with first degree AV block, right bundle branch block and left anterior fascicular block.'''


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Latest revision as of 15:38, 11 November 2008

This page is part of Cases and Examples

Previous ECG: Case 3 | Next ECG: Case 5

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.


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