Answer MI 20

The ECG

• Following the 7+2 steps:
  • Rhythm
    • The ECG shows a regular rhythm with normal P waves (positive in I, III and AVF, negative in AVR), followed by QRS complexes. Sinusrhythm
  • Heart rate
    • 100 bpm
  • Conduction (PQ,QRS,QT)
    • PQ: 140ms QRS: 100ms QT: 320ms QTc: 410ms
  • Heartaxis
    • QRS positive in I and AVF: normal heart axis
  • P wave morphology
    • The P waves have normal morphology.
  • QRS morphology
    • Narrow QRS. No left ventricular hypertrophy. No pathologic Q waves.
  • ST morphology
    • ST elevation in V1-V4 and lead I. ST depression in II, III, AVF and V6. Lead V3 shows V4R which is not elevated
  • Compare with the old ECG (not available, so skip this step)
  • Conclusion?

Sinusrhythm with anteroseptal infarction. Ischemic vector is pointing upwards (ST depression in AVF), a sign of proximal LAD occlusion.