OK - This lead wasn't  to hard right?
 

Basics - 

• Rate is about 36-38 min
• Regular Rhythm
• There is an absent P-R interval
• There are more P waves than QRS
• Elevation in lead III and Depression in V1 and V2.
   

What is it?

Third Degree heart block with Inferior/Posterior wall MI.
 

Discussion -

There are many more P waves than QRS complexes. The P-R interval constantly change. So there is no fixed atrial and ventricular activity relationship. The ventricular activity consists of narrow QRS that are best seen in lateral V4-V6, since the ST segments are baseline in those leads. P waves are rounded and upright. A-V dissociation results from the Third Degree block.

An acute injury is seen in leads II, III and AVF with elevation above the baseline. Reciprocal changes can be seen with ST depression in leads I and VL.
 
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