Example 14

The ECG

• 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.