Answer MI 19

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Previous ECG: MI 18 | Next ECG: MI 20

Where is this myocardial infarction located?

ECG MI 19. Click on image for enlargement.


  • Following the 7+2 steps:
    • Rhythm
      • Regular rhythm with normal P waves (positive in I, II, negative in AVR), followed by QRS complexes. Sinusrhythm
    • Heart rate
      • 46 bpm. Thus sinusbradycardia
    • Conduction (PQ,QRS,QT)
      • PQ: 170ms QRS: 110ms QT: 420ms QTc: 370ms
    • Heartaxis
      • Positive in I and AVL: normal heart axis
    • P wave morphology
      • P wave positive in II, bifasic in V1. Not well discernible in AVF. Seems normal.
    • QRS morphology
      • Pathologic Q waves in III and AVF. Slow R wave progression. Some aspecific intraventricular conduction delays (QRS 110ms).
    • ST morphology
      • ST elevation in II, III (III>II), AVF, V5 (1 mm elevation V4 and V6). ST depression in I and AVL. Lead V3 shows V4R and is not elevated.
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?

Inferior myocardial infarction with Q waves in the inferior leads; probably due to RCA occlusion (III>II, depression in I)