Rattibha

Andrew Sanchez M.D.

7 Tweets 11 reads Apr 06, 2023

2 early repolarization variants (funky ST-T segments) to learn & save!
♥️ Benign early repolarization
♥️ Benign T-wave inversion
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Benign early repolarization (BER):
♥️ Widespread concave ("smiley-face") ST elevation, most prominent in V2-V5
♥️ Notching/slurring at J-point ("fish hook")
♥️ Prominent, slightly asymmetric T-waves
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Benign T-wave inversion (BTWI):
⬇️ Usually V3-V6 w/ frequent TWI also in inf. leads
⬇️ Often very distinct J-waves co-existing w/ TWIs
⬇️ Preceded by Small S-waves & Rampant R-waves
⬇️ Right-sided precordium often has ST elevation typical of BER
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If found, what next?
♥️ BER/BTWI are frequently benign, but history matters!
♥️ Elicit history of active cardiopulmonary symptoms & FHx of sudden cardiac death, because concerning history should prompt further work-up
♥️ In other words, BER/BTWI aren't always benign!
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If chronically-evolving ST/T segment changes, what next?
♥️ Read @PendellM's post below & consider fluctuating normal variant vs. occlusive MI
♥️ Here are some ECGs from that blog post showing fluctuation of an individual's early repolarization
hqmeded-ecg.blogspot.com
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