GNT Giant negative T ,defined as more than 10mm Deep T inversions (Yamaguchi et,al )

What are the important differentials when you see this rare ECG pattern ?

Easy case but still medical errors could happen
45 year female coming with acute onset central chest pain for the last 4 hours
Triage as CAT 2 , now machine concerned about acute ischaemia

Thoughts ?

64 Male Hypertension only past
4 days Hx of exertion induced SOB
Stable OBS Cat 3
ECG below 👇

Patient with a syncope
S wave up stroke Will be more than 55 msec in V1 , V2

Which important cardiac pathology you would be concerned of ?

Asanka Migelheva 🤙🏻. ahajournals.org/doi/10.1161/01…

Asanka Migelheva Screenshot below from Ken Grauer, MD's excellent blog, link: ecg-interpretation.blogspot.com/2013/01/ecg-in…

Takotsubo and CNS disorders are the only ones that tend to cause gross QT prolongation

81 year old BG of DM and Hypertension
4 hours Hx of acute central chest pain
ECG below .
She is otherwise stable.
Worried of an OMI ?

Early repolarisation pattern in the ECG

Seems to be not so benign always
Matters in the Emergency department ?
Yes
Chest pain —- leads to diagnostic confusion

Syncope ——- think about ER syndrome

#ECG Features of RV enlargement;
1. Rbbb
2. RV strain pattern
3. S wave in V6

Bifascicular block - RBBB + LAFB

Possible diagnosis;
1. Acute PE
2. Chronic Respiratory Disease like OSA/OHS/COPD

Asanka Migelheva Pre- excitation ECG: Left Posterolateral accessory pathway

classical ECG changes which demarcate STEMI vs acute pericarditis “Pericarditis can cause localised ST elevation but there should be no reciprocal ST depression (except in AVR and V1)”

I have seen few cases which will challenge this teaching remotely
Your experiences ?

Pseudoischaemia. Pre-excitation #ECG ; Left Posterolateral Accessory pathway.

Asanka Migelheva OMI sign detected‼️‼️🚑🚑

🔺LAD OMI

Asanka Migelheva OMI sign detected‼️‼️🚑🚑

🔺Acute pLAD

24 M Hx of acute pericarditis 2 years back ( no records available )

Progressive exertion induced SOB over the past 6 months and now for past week having pleuritic type chest pain
What do you think about the ECG ?

Shallow symmetrical T inversions with a broad base in V1–V3 in acute RV strain

Last 4 cases with large Clot burden PE had similar appearance
Any similar experiences
Arnel Carmona Stephen W. Smith Pendell Meyers Adrian Baranchuk MD FACC FRCPC FCCS FSIAC David Didlake Amal Mattu Sam Ghali, M.D. Brooks Walsh and others pls

OMI sign detected ‼️‼️🚑🚑

🔺Acute pLAD occlusion

Asanka Migelheva Features of RV enlargement;
1. Rbbb
2. RV strain pattern
3. S wave in V6

Bifascicular block - RBBB + LAFB

Possible diagnosis;
1. Acute PE
2. Chronic Respiratory Disease like OSA/OHS/COPD