Example 14

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  • Following the 7+2 steps:
    • Rhythm
      • The ECG shows an irregular rhythm. There are no P waves. Atrial fibrillation.
    • Heart rate
      • 150 bpm
    • Conduction (PQ,QRS,QT)
      • PQ: not appropiate QRS: 110ms QT: 360ms QTc: 560ms (prolonged)
    • Heartaxis
      • QRS positive in I and iso-electric in AVF: horizontal heart axis
    • P wave morphology
      • No P waves present
    • QRS morphology
      • Incompleter right bundle branch block. QS V4-V6. Q in III and AVF.
    • ST morphology
      • ST elevation in III,AVF and V6. ST depression in I, AVL, V2.
    • Compare with the old ECG (not available, so skip this step)
    • Conclusion?

Atrial fibrillation with inferior-posterior-lateral myocardial infarction and incomplete right bundle branch block. Lead I shows ST depression, suggestive of right coronary artery involvement.