OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• cardiology
• basics of the ECG
  • ECG - flat T waves
  • an approach to the ECG with ST elevation
  • ECG Diagnosis of AMI
• the adult patient with chest pain in the ED

• tall T waves on the ECG may represent a life threatening condition - see aetiology below

• hyperkalaemia - usually tall narrow symmetric peaked T waves
• hyperacute T waves of acute coronary ischaemia
  • usually broad, asymmetrically peaked which may be an early sign of acute myocardial infarction (AMI/STEMI/NSTEMI) but can also be in Printzmetal angina
  • upright T wave in V1 is considered abnormal and may represent a hyperacute T wave, especially if tall or new
  • T wave should be taller in V6 but if this is not the case, this loss of concordance suggests hyperacute T waves
• de Winter syndrome
  • tall, prominent, symmetric upright (“hyperacute”) T waves in precordial leads with up-sloping ST segment depression ( > 1 mm) at the J-point esp. in V2-4 and 0.5-1mm ST elevation in aVR
  • indication for emergent cardiac cath
• toxicities
  • eg. clonidine overdose

• hypermagnesaemia
• normal variant
• benign early repolarisation
  • peaked, slightly assymetric (descending limb more vertical) with concave ST elevation and a notched J-point
  • found on 3-5% of young adults and it seems may be associated with an increased risk of idiopathic VF at some stage
  • see https://litfl.com/benign-early-repolarisation-ecg-library/

• ventricular hypertrophy
  • precordial leads
• LBBB
• pericarditis