Another interpretation of the last rhythm strip, b.

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Left Bundle Branch Block with Less Than 1 mm of Co.

Atypical Chest Pain: Suspicious ECG, and a Left Ma.

The Usefulness of PVCs: Video Talk by K.

Series of Prehospital ECGs Showing Reperfusion.

PVC or Aberrant Conduction? (Another Guest Post fr.

24 yo woman with chest pain the morning after bing.

Brugada pattern induced by tricyclic antidepressant.

Woman in her 60's with 1 hour of chest pain.

V2 and V3 are another example of posterior reperfusion T-waves.Īngiogram showed an open culprit artery supplying the inferior and posterior walls

T-waves are upright in V4-V6, reciprocal to the inverted T-waves in V7-V9, but not exactly because these are not 180 degrees opposite each other. Here is t = 14 minutes (simultaneous to previous): There are mostly inverted T-waves in V7-V9, pretty much reciprocal to (opposite of) V2 and V3. Now there are inverted (reperfusion) T-waves in the inferior leads, with a reciprocally upright T-wave in aVL. Here is t = 13 minutes, with posterior leads V7-V9: Clearly, this is a reperfusing inferoposterior MI. Now inferior T-waves are not at all hyperacute and the precordial T-waves are mostly upright.

Inferior T-waves are slightly smaller, and there is less negativity to the T-waves in V2 and V3 The chest pain began to resolve after NTG (t = 2 minutes): (Alternatively, if you see a down-up T-wave, it may actually be a down T-wave followed by an upright U-wave, if it happens very late.) Thus, this is probably inferior-posterior STEMI, possibly with some degree of reperfusion. 'Down-up' biphasic T-waves should always be thought to be reciprocal of 'up-down' (Wellens' type) reperfusion T-waves.

There are inferior hyperacute T-waves, with reciprocally inverted hyperacute T-wave in aVL, and a biphasic (down-up) T-wave in V2 and V3, as well as ST depression in I and V4-V6. Medics recorded this ECG at time 0 in a patient with chest pain:

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