#STD_in_right_vent_hypertrophy
right ventricular hypertrophy (RVH) causes ST depression and T-wave inversion in the right precordial leads V1-3.

#STD_IN_SVT:_
Supraventricular tachycardia (e.g. AVNRT) typically causes widespread horizontal ST depression, most prominent in the left precordial leads (V4-6).
This rate-related ST depression does not necessarily indicate the presence of myocardial ischaemia, provided that it resolves with treatment

#ST_depression_in_hypokalemia:_
Hypokalaemia causes widespread downsloping ST depression with T-wave flattening/inversion, prominent U waves and a prolonged QU interval

#Morphology_of_ST_Depression
ST depression can be either upsloping, downsloping, or horizontal.
#Horizontal or #downsloping ST depression ≥ 0.5 mm at the J-point in ≥ 2 contiguous leads indicates myocardial ischaemia (according to the 2007 Task Force Criteria).
#Upsloping ST depression in the precordial leads with prominent De Winter T waves is highly specific for occlusion of the LAD.
Reciprocal change has a morphology that resembles “upside down” ST elevation and is seen in leads electrically opposite to the site of infarction.
#Posterior MI manifests as horizontal ST depression in V1-3 and is associated with upright T waves and tall R waves.

#STD_in_digoxin_treatment:_
Treatment with digoxin causes downsloping ST depression with a “sagging” morphology, reminiscent of Salvador Dali’s moustache

Diagnosis ?

A 28-year-old patient presents with weakness and muscle cramps.

Diagnosis?

Ecg stripe showed
deeply inverted T waves in high lateral chest leads with T wave inversion also in leads I, II, avl and avf.
SUSPECT APICAL HCM (Yamaguchi Hypertrophic Cardimyopathy)...next step is echo

🫀 100 Echo Signs Every Cardiologist Should Know

B-BUMP SIGN

📈 A classic M-mode clue to elevated LV filling pressure

🔍 WHAT IS THE B-BUMP?
The B-bump is an abnormal late-diastolic configuration of the mitral valve seen on M-mode echocardiography.

It appears as a small bump or plateau between the A and C points, with the mitral valve remaining partially open before closure.





⏱️ WHEN DOES IT OCCUR?

⚠️ The B-bump is a LATE-DIASTOLIC phenomenon.
It occurs after the A point and before mitral valve closure (C point).

🔍 WHY DOES IT OCCUR?
⬆️ LV end-diastolic pressure ⬇️ Transmitral pressure gradient during late diastole ➡️ Mitral leaflets remain partially open ➡️ Abnormal late-diastolic leaflet motion ➡️ B-bump

❤️ CLINICAL ASSOCIATIONS
The B-bump has been described in:
🔸 Elevated LVEDP
🔸 Reduced LV compliance
🔸 Severe LV systolic dysfunction
🔸 Ischemic cardiomyopathy
🔸 Dilated cardiomyopathy



💡 ECHO PEARL

📈 B-BUMP = LATE-DIASTOLIC MITRAL LEAFLET ABNORMALITY

ECG diagnosis: Acute myocardial injury in the setting of complete left bundle branch block (LBBB).

Key findings:
- Sinus rhythm
- Complete LBBB with left-axis deviation
- Concordant ST-segment elevation in the anterior precordial leads
- Concordant ST elevation in a patient with ischemic symptoms is highly concerning for acute coronary occlusion

This is a high-risk ECG. LBBB alone does not establish acute MI, but concordant ST-segment elevation markedly increases concern for acute myocardial infarction.

Clinical context is critical: severe ongoing ischemic symptoms plus these ECG findings should prompt immediate ACS evaluation and cardiology/reperfusion pathway activation.

Persistence of atrioventricular nodal re-entrant tachycardia during ventricular fibrillation