Answers example 1 question 1

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Answers and below the case will continue!

  • Describe the ECG according the 7 + 2 step plan
    • Rhythm
      • This is a regular rhythm and every QRS complex has a P-wave in front of it. The P wave us positive in II, III and AVF and comes from the sinusnode. So it's a sinusrhythm.
    • Heartrate.
      • Use the 'counting methode' (3 large grids ~> 300-150-100), so 100/min.
    • Conductiontimes (PQ,QRS,QT)
      • PQ-time=0.16sec (4 small grids), QRS duration=0.10sec, QT time=280ms, QTc interval=361 ms
    • Heart axis
      • Isoelectric in I, positive in II, III and AVF. Therefore it is a vertical heartaxis.
    • P wave morphology
      • The p wave is possibly > 2,5 mm in II (hard to see, a good millimetergrid is lacking), so there could be right atrium overload.
    • QRS morphology
      • Pathologic Q in AVL, V1-V3 and possibly V4-5 (poor quality). Hardly any precordial R-wave progression.
    • ST morphology
      • ST elevation in V2-V5 and in I,AVL.
    • No prior ECG to compare
    • Conclusion. What's going on?

Answer: A large anterior wall infraction

Additions: and possibly right atriumoverload caused by backwardfailure of the left ventricle.

ECG on admission

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