Answer Case 5

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Previous ECG: Case 4 | Next ECG: Case 6


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


  • Following the 7+2 steps:
    • 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 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.
    • Heart rate
      • around 80 bpm
    • Conduction (PQ,QRS,QT)
      • PQ: not applicable. QRS: 110ms QT: 380ms
    • Heartaxis
      • Positive in I and II, negative in III. Slightly positive in AVF. An intermediate heart axis.
    • P wave morphology
      • The P waves that are present seem to have a normal morphology.
    • QRS morphology
      • Slightly broad QRS complexes. QS in V1.
    • ST morphology
      • Negative T in III oreceded by a negative QRS complex (normal).
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?

Nodal rhythm in competition with sinusrhythm.