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لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟

ECG Pearl 🫀
لو لقيت ST elevation في V1–V3، إيه الـclinical context اللي يخليك تفكر في Brugada Syndrome بدل Acute MI؟

سؤال سريع لأطباء القلب ⚡
إيه الـECG finding اللي ممكن يكون علامة مبكرة على Acute Pericarditis؟

سؤال اليوم لأطباء القلب:

إيه الـ ECG finding اللي ممكن يخليك تشك في Cardiac Amyloidosis رغم إن الـEcho بيظهر LVH؟ 🤔

سؤال اليوم 🫀
إيه الـECG pattern اللي لازم يخليك تفكر في Hyperkalemia حتى قبل ظهور الأعراض؟ ⚡

ECG Interpretation

Sinus rhythm with left atrial enlargement and complete left bundle branch block (LBBB).

QRS duration ≥120 ms.

Broad, notched/slurred R waves in I, aVL, V5–V6.

Absent q waves in the lateral leads.

QS/rS pattern with broad S waves in V1–V2.

Delayed intrinsicoid deflection >60 ms in the left precordial leads.

Secondary ST-T changes: ST depression and T-wave inversion in I, aVL, V5–V6.

QRS axis may be normal or leftward.


Conclusion: Sinus rhythm + Left atrial enlargement + Complete LBBB with secondary ST-T changes.

A 57-year-old man is referred in by his GP following two weeks of episodic left axillary pain. HR 73, BP 134/64, SpO2 97 RA.

He is pain free at triage when the following ECG is taken:

A 65-year-old woman presents with one hour of central chest pain following three days of exertional dyspnoea and lethargy. BP 79/51, HR 105 reg, SpO2 93 RA

Normal sinus rhythm, rate 100 bpm
Right bundle branch block
Widespread ST depression, most notable in leads II and V4-6. Even in the context of RBBB, ST depression in V2-3 is excessively discordant
ST elevation in aVR ~1mm

This ECG pattern simply represents diffuse subendocardial ischaemia due to oxygen supply-demand mismatch. It is the same ECG seen in patients that have a positive stress test. Note that ST elevation in aVR here is a reciprocal change to ST depression most marked in leads I, II and V4-6.

Some common clinical causes of this include:

Hypotension or hypoxia
Left main coronary artery (LMCA) or left anterior descending artery (LAD) stenosis/insufficiency
Severe triple vessel disease
ROSC post cardiac arrest
In the absence of ST elevation in other leads, acute coronary occlusion is rarely the cause of this ECG pattern.

ST elevation in aVR due to LMCA or “left main” occlusion is a misnomer — such a lesion causes simultaneous anterior, posterior and lateral STEMI leading to almost instantaneous death

An 88-year-old man is brought in by ambulance complaining of palpitations. BP 133/75, SpO2 100, GCS 15.

HR is fixed at 150 bpm. Is this atrial flutter?

Regular narrow complex tachycardia, rate 150 bpm
Left anterior fascicular block
ST depression in V2-5 is suggestive of rate-related ischaemia
There is a long R-P interval, with P waves visible buried in the end of the T wave. These are seen as an additional positive deflection in lead II. Similarly upright P waves in aVL may be easily mistaken for T waves, which are actually inverted and visible just prior
P wave axis is abnormal with a leftward deviation
The third complex is a ventricular ectopic beat (VEB). Note that if this were a functional bundle block due to rate or aberrancy, we would expect the rate to change

Lead II: Upright P waves visible at the end of the T wave

aVL: Upright P waves (red arrows) could easily be mistaken for inverted T waves (blue arrows)

In patients with a regular narrow complex tachycardia and a long R-P interval, our differentials include:

Focal atrial tachycardia (FAT)
Atypical AVNRT
Permanent junctional reciprocating tachycardia (PJRT)
Atypical AVNRT and PJRT both produce retrograde P waves from a focus near the AV node – we would therefore expect a negative P wave axis in inferior leads, which is not the case here. An abnormal P wave axis here with an upright P wave in lead II suggests FAT as the most likely rhythm.

A 78-year-old man with a history of coronary artery bypass surgery presents to the emergency department with symptoms of dizziness and palpitations. He has a history of tobacco use, diabetes mellitus, and hypertension. His medications include metoprolol succinate, lisinopril, aspirin, and atorvastatin. Upon arrival at the emergency department, the patient's blood pressure is 80/45 mm Hg with a heart rate of 180 bpm. He appears mildly distressed. An electrocardiogram (ECG) is obtained..

What is ECG diagnosis ?

#ecginterpretation #doctor #cardiologists #HeartHealth #ekg

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25-year-old female with ‘palpitations’. BP 117/72, GCS 15.

Regular narrow complex tachycardia, rate 132 bpm
Slight right axis deviation
Dominant R wave in V1 meets voltage criteria for right ventricular hypertrophy (RVH)
Pseudo R’ waves in the terminal portion of the QRS in V1, an isoelectric baseline, and lack of flutter waves in V1 point towards this rhythm being an AV nodal re-entry tachycardia (AVNRT)
No rate-related ischaemia
There is one other feature on this ECG that suggests this patient has a congenital structural abnormality, can you spot it?