Answer MI 14

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  • Describe the ECG according to the 7 + 2 stepplan
    • Rhythm
      • This is a regular rhythm and every QRS complex is preceded by a p wave. The p wave is positive in II, III and AVF and originates form the sinusnode. Conclusion: sinusrhythm.
    • Heartfrequency.
      • Use the 'Countingmethod' (6 big grids ~> 300-150-100-75-60-50), so 50/min.
    • Conductiontimes (PQ,QRS,QT)
      • PQ-tijd=0.16sec (4 small grids), QRS duration=0.10sec, QT time=460ms
    • Heartaxis
      • Positive in I, iso-electric in II, negative in III and AVF. So, a left axis.
    • P wave morphology
      • The p wave is normal shaped.
    • QRS morphology
      • Conductiondelay right, btu not enough for the RBBB criteria (QRS < 0.12s). Slow R-wave progression in the precordial leads.
    • ST morphology
      • ST elevation in II,III and AVF. Reciprocal depression in I, AVR and AVL with negative T waves. Additionally discrete elevation in V2-V5. And ST-elevation in V4R
    • Compare with the old ECG (not available)
    • conclusion. What is going on?

Answer: Inferior wall infarct with right ventricular involvement and:

  • Sinusbradycardia, probably because the sinusnodebranch, coming form the RCA is lacking perfusion.
  • Left heart axis
the ECG

This is a right lead ECG