Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Littmann’s EKG Course: The ST Segment

  • When faced with a QRS with a terminal "notch" and hammock shaped ST's:
    • Consider pericarditis if tachycardic.
    • Consider benign early repolarization if normal rate.
    • Consider hypothermia if bradycardic.

      Tachycardia, PR depression in lead II, and PR elevation in aVR is concerning for pericarditis.

      Benign Early Repolarization

      In the setting of normal rate and a young healthy patient, this EKG is most consistent with benign early repolarization.


      Osborn waves with hypothermia look similar to the above two examples but are seen in bradycardia.

  • The "aVR sign." Chest pain, ST elevation in aVR and diffuse ST depressions is 80% sensitive for LAD main and high mortality.

    aVR sign

    Pay close attention to aVR in this EKG; this patient has a 100% occlusion to the LAD.

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