3rd ECG Workshop:

ST segment, T wave, U wave

and QT interval
Basically everything after QRS complex
ST-segment …
ST segment elevation 1a. STEMI
https://youtu.be/h367IH2D-4A
https://www.youtube.com/watch?v=2bGs-KZbyCs
Middle-aged patient presenting with chest
pain. Describe the ECG.
70-year old patient presenting with chest
pain and diaphoresis. Describe the ECG.
53 yo male with central chest pain
53 yo male w/ central chest pain mirror sign
53 yo male w/ central chest pain
 https://www.youtube.com/watch?v=WaQg6bFJdYc

Another chest pain patient

ECG repeated 9 mins later
aVR ST elevation
 • LMCA stenosis
 • proximal LAD stenosis
 • severe triple disease
 • hypoxia/hypotension
ST segment elevation 1b. LBBB
• How do you tell if a patient with LBBB has an MI if LBBB has ST
segment elevation?
A total score of ≥ 3 is reported to have a specificity of 90% for diagnosing myocardial infarction.
LBBB + STEMI, “inappropriate” concordance
ST segment elevation 1c. pericarditis
ST segment elevation 1d. Brugada
syndrome
ST segment elevation 1e. LV aneurysm
T waves …
Tall T wave – Hyperacute T wave MI
Tall T wave – De Winter T waves
Tall T wave – peaked T = hyper K
More hyper K
Guess what am I?
Guess what am I?
Biphasic T waves – Wellen’s syndrome type
A
Inverted T wave – Wellen’s syndrome type
B
Biphasic T wave - hypokalaemia
What happened here?
Chest pain, dyspnoea, BP 90/50, SaO2
83%
Inverted T wave – Cerebral T wave
QT interval - prolonged
 QT Interval Prolonged
• Corrected QT interval (QTc)
• The corrected QT interval (QTc) estimates the QT interval at a
standard heart rate of 60 ppm
• This allows comparison of QT values over time at different heart
rates and improves detection of patients at increased risk of
arrhythmias
• Calculate the corrected QT interval (QTc)
1.Step 1: calculate the QT interval
2.Step 2: calculate the R-R interval (in seconds)
3.Step 3: QTc = QT / √RR
• Note: The RR interval is given in seconds (RR interval = 60 / heart rate)
 QT Interval Prolonged
• Rules
1.QTc is prolonged if > 440ms in men or > 460ms in women
2.QTc > 500 is associated with an increased risk of torsades de pointes
3.QTc is abnormally short if < 350ms
4.A useful rule of thumb is that a normal QT is less than half the preceding
RR interval
Risk of TdP
What do you see here?
References
• https://ecgwaves.com/topic/stemi-st-elevation-myocardial-
infarction-criteria-ecg/
• https://ecgwaves.com/topic/the-st-segment-j-point-j-60-
point-st-depression-st-elevation/
• https://ecgwaves.com/topic/ecg-myocardial-ischemia-
ischemic-changes-st-segment-t-wave/
•
Quiz time!
30-year old male presenting with syncope. Describe the
ECG.
These ECGs were taken from a 40 yr old male who presented
with a 60 minute history of central chest pain. Now pain free
Four minutes later he developed further intense chest
pain and a repeat ECG was performed
Middle aged patient presenting with central chest pain.
What does the ECG show?
31 yr old female who is 5 days post-partum she was brought to the Emergency
Department following a episode of collapse. On arrival to the Emergency
Department she was hypotensive (systolic BP ~80 mmHg) with an altered
conscious level, complaining of chest pain and headache.
Following review of the initial ECG urgent cardiology input was obtained and an emergent CTPA was
performed to exclude PE as a potential cause.

On return from a negative CTPA the patient complained of further chest pain, repeat ECG below:



Elderly patient presenting with sudden onset of chest pain and
shortness of breath. Hypoxic (SaO2 82% RA) and hypotensive
(80/50). Describe and interpret his ECG
 The End
Now you know a little about ECG… Hooray !