Benign early repolarization

·     Normal finding in young, healthy patients

·     a.k.a. high take off, J point elevation

·     Mainly in V2-5

·     Concave ST elevation + notched J point + asymmetrical T wave

·     Absence of reciprocal ST depression elsewhere

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·     LVH criteria

·     Septal pattern: dagger-like Q waves laterally and inferiorly

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·     Apical pattern; giant inverted T waves praecordially


·     Na+ channelopathy

·     ST elevation in V1-3

·     Type 1: coved shape

·     Type 2: saddle shape

·     Type 3: either but <2mm

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·     Accessory pathway between atria and ventricle (Bundle of Kent)

·     Resting: ↓PR interval, ↑QRS, slurred upstroke (δ) in V1, abnormal T wave

·     Pre-excited AF: if AF and VT had a baby

o   NO: give node blocking drugs (adenosine, b-blocker, CCB)

o   YES: cardioversion, flecainide (normal LV), amiodarone (abnormal LV)

·     Orthodromic SVT:

o   Looks like vanilla SVT

o   Treated like vanilla SVT

·     Antidromic SVT:

o   Looks like VT

o   Treated like VT

Lung disease

Findings can include:

·     Right axis deviation

·     Atrial arrhythmias

·     P pulmonale

·     RBBB

·     RVH

·     RV strain pattern

RV strain

·     ST depression, T wave inversion V1-4 and inferiorly


1.   Tall, tented T waves

2.   Small or absent P waves

3.   Widened PR

4.   Widened QRS

5.   Sine wave

6.   Asystole


·     Repolarisation: ST depression, T wave flattening, ±U wave

·     Conduction: AV block, prolonged QT

·     Ectopy: PAC, PVC, VT if severe

Digoxin effect

·     Reverse tick

·     Especially lateral leads

·     Can be widespread

·     N.B. does not indicate toxicity (that’s VT or VF)

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·     Conduction delay (as if ‘pulled apart’)

·     Tachyarryhthmias (VT, VF)