12-Lead Electrocardiographya comprehensive course

Adam Thompson, EMT-P, A.S.

STE-Mimics

Part 3

Benign Early Repolarization (BER)

• BER may present with an appearance of ST-elevation. • Notched J points are the most commonly taught indicator

of “early repol”.• The ST-segment morphology is the easiest way to

determine malignancy of the finding.• LOOK for reciprocal changes!!!

Early Repolarization

Early Repolarization

ST-Segment Morphology

• Concave ST-Elevation is generally more benign.– However, an MI may present with concave

ST-Elevation.

• Convex ST-Elevation is almost always an indication of an MI.

Concave Convex

J-Point J-Point

Benign Early Repolarization

• Notched J-Points are sure indicators of benign early repolarization

Early Repolarization

Early Repolarization

Early Repolarization

Right Bundle Branch Block

• A conduction delay due to blockage of the only right fascicle.

• ST-segment usually not altered by the normal T wave discordance of RBBB.

• QRS duration > 120 ms with positive terminal QRS deflection in V1.

Right Bundle Branch Block

Right Bundle Branch Block

END

• More in the next lesson…