Tasty Morsels of EM 022

6 Oct

From the recently discovered (for me anyhow) ECG Pedia.org

Early repolarisation remains a challenge for me. I know (in a gut way) looking at it when it seems normal and when it looks not quite right. But I’ve never been clear where the J-point was and when it was allowed to be high take-off and when it wasn’t.

Here are a few tips from the site:

  • an upward concave elevation of the RS-T segment with distinct or “embryonic” J waves
  • slurred downstroke of R waves or distinct J points or both
  • RS-T segment elevation commonly encountered in the precordial leads and more distinct in these leads
  • rapid QRS transition in the precordial leads with counterclockwise rotation
  • persistence of these characteristics for many years (in other words if it looks different in the 2nd ECG then worry)
  • absence of reciprocal ST depression
  • large symmetrical T waves

And a nice pic to show it:

Click for source

One of the best papers I’ve seen on ST elevation is this one from the NEJM:

Wang K, Asinger RW, Marriott HJL. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med 2003 Nov.;349(22):2128–2135. PMID 14645641

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