Answer MI 18

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Previous ECG: MI 17 | Next ECG: MI 19

Where is this myocardial infarction located?

ECG MI 18. Click on image for enlargement.


  • Following the 7+2 steps:
    • Rhythm
      • Regular rhythm with narrow QRS complexes without P waves. Probably a nodal escape rhythm with either atrial standstill or atrial fibrillation with AV block
    • Heart rate
      • 41 bpm
    • Conduction (PQ,QRS,QT)
      • PQ: not applicable QRS: 100ms QT: 450ms QTc: 370ms
    • Heartaxis
      • Negative in I, positive in II and AVF, thus a right axis deviation.
    • P wave morphology
      • No P waves present.
    • QRS morphology
      • Narrow QRS, no pathologic Q waves, normal precordial R wave progression. A notch is seen in the terminal part of the QRS complex in V5/V6.
    • ST morphology
      • ST elevation in I, II, III, AVF, V6. ST depression in AVR, AVL, V1-V5. No ST deviation in V4R
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?

Inferior-posterior-lateral myocardial infarction with a nodal escape rhythm - probably due to RCX occlusion