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Upright T wave in V1

A 65 year old woman presents with a 20 minute episode of chest pain. Her ECG is shown below. Are there any concerning features for ischaemia? Significance of an upright T wave in V1 Normally the T wave is inverted or flat in lead V1. An upright T wave in V1 may be considered a…

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The ECG of Athletes: Normal variations you must know.

The ECG of the athletes can pose a challenge in distinguishing pathological changes from those physiological changes, that are associated with physical training and cardiac remodelling. We don’t want to erroneously attribute heart disease to those with normal variants and more importantly, we don’t want potentially life threatening cardiac conditions being erroneously dismissed as normal…

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Syncope

Syncope is one of those conditions you either love or hate. I certainly have at least five presentations of patients with syncope per shift. Having an approach to those patients certainly helps minimise missing the big stuff. Remember that syncope is a symptom and we need to find the diagnosis. The detective work is about…

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Wellen’s Syndrome

Wellen’s Syndrome is one of those syndromes that all emergency physicians know about. It’s probably also one of those syndromes that the emergency community introduced to clinicians everywhere. It was first described as an inverted U wave as early as 1980 and then introduced by Wellen in 1982 as Wellen’s syndrome, the name by which…

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Spodick’s Sign and Pericarditis

Spodick’s Sign appears in Stage I of Pericarditis and is a downsloping of the TP line ie., the baseline. It is said to be present in some 80% of cases of acute pericarditis and is best visualised in lead II and the lateral precordial leads(1).       The ECG findings of pericarditis are important…

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Pseudo-Wellens’ Syndrome

I recently saw post-op patient sent down to the ED (no ICU at this hospital), who had biphasic T wave changes in her anterior leads and had complained of chest pain, which was relieved with anginine. The patient was discussed with cardiology and transferred to coronary care. In this patient there was no doubt that this…

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