Septal v1 2 anterior v3 4 lateral i avl v5 6 inferior

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Septal (V1-2) Anterior (V3-4) Lateral (I + aVL, V5-6) Inferior (II, III, aVF) Right ventricular (V1, V4R) Posterior (V7-9) Anterolateral STEMI 78
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Pericarditis BER LBBB LV aneurysm Brugada ST Segment Morphology in Other Conditions 79
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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. Reciprocal change has a morphology that resembles “upside down” ST elevation and is seen in leads electrically opposite to the site of infarction. ST Depression 80
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Myocardial ischemia / NSTEMI Reciprocal change in STEMI Posterior MI Digoxin effect Hypokalemia Causes of ST Depression Treatment with digoxin causes downsloping ST depression with a “sagging” morphology, reminiscent of Salvador Dali’s moustache. 81
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Osborn Wave (J Wave) The Osborn wave (J wave) is a positive deflection at the J point (negative in aVR and V1) It is usually most prominent in the precordial leads Characteristically seen in hypothermia (typically T<30C) 82
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83 J waves in severe hypothermia
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Benign early repolarisation (BER) is a ECG pattern most commonly seen in young, healthy patients < 50 years of age. It produces widespread ST segment elevation that may mimic pericarditis or acute MI. Normal variant that is not indicative of underlying cardiac disease. Less common in the over 50s 84 Benign Early Repolarisation(J Point)
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Widespread concave ST elevation , most prominent in the mid- to left precordial leads (V2-5). Notching or slurring at the J-point. Prominent, slightly asymmetrical T-waves that are concordant with the QRS complexes (pointing in the same direction). The degree of ST elevation is modest in comparison to the T-wave amplitude (less than 25% of the T wave height in V6) 85 How to recognise BER ?
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Widespread concave ST elevation , most prominent in the mid- to left precordial leads (V2-5). Notching or slurring at the J-point. Prominent, slightly asymmetrical T-waves that are concordant with the QRS complexes (pointing in the same direction). The degree of ST elevation is modest in comparison to the T-wave amplitude (less than 25% of the T wave height in V6) 86 How to recognise BER ?
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ST elevation is usually < 2mm in the precordial leads and < 0.5mm in the limb leads , although precordial STE may be up to 5mm in some instances. No reciprocal ST depression to suggest STEMI (except in aVR). ST changes are relatively stable over time (no progression on serial ECG tracings). 87
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88 There is generalised concave ST elevation in the precordial (V2-6) and limb leads (I, II, III, aVF). J-point notching is evident in the inferior leads (II, III and aVF).
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89 Widespread ST elevation and PR depression Reciprocal ST depression and PR elevation in V1 and aVR Pericarditis
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The epsilon wave is a small positive deflection (‘blip’) buried in the end of the QRS complex.
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  • Winter '16
  • jean grey
  • Cardiac electrophysiology, QRS, Rate

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