2. Benign Early Repolarization (BER)
Burns E. Benign Early Repolarization (April 2, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/benign-early-repolarisation/
3. BER
It is seen in young
healthy individuals as:
•widespread ST segment
elevation that may mimic
pericarditis or acute MI
4. ECG features
widespread concave ST elevation <2 mm with no
progression over time, most prominent in V2-V5
notching or slurring at the J-point
prominent, slightly asymmetrical T-waves concordant
with the QRS complexes
no reciprocal ST depression
5. BER
Concave widespread ST elevation (<2 mm).
Notching at J point!
T waves are concordant with QRS complexes.
6. Be careful if:
Myocardial
ischaemia
It is an older
patient!
If there is convex
ST-elevation and
>2 mm!
There are
symptoms
suggesting
myocardial
ischaemia!
T waves are
discordant with QRS
complexes!
7. Beta-blocker toxicity
Burns E. Beta-blocker and Calcium-channel blocker toxicity (April 10, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/beta-blocker-and-calcium-channel-blocker-toxicity/
11. Propranolol toxicity
• Propranolol blocks myocardial and
CNS fast sodium channels.
• It behaves like a tricyclic
antidepressant in overdose.
• Signs of sodium channel blockade in
propranolol toxicity are QRS widening
and a positive R’ wave in aVR.
12. Sotalol toxicity
• Sotalol blocks myocardial
potassium channels.
• Signs of excessive myocardial
potassium channels blockade are
QT prolongation and Torsades de
Pointes.
17. Bifascicular Block
Burns E. Bifascicular Block (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/basics/bifascicular-block/
18. ECG features
Combination of right bundle
branch block (RBBB) with
either left anterior fascicular
block (LAFB) or left posterior
fascicular block (LPFB).
19. Causes
• Ischaemic heart disease (40-60%)
• Hypertension (20-25%)
• Aortic stenosis
• Anterior MI (5-7% of acute AMI)
• Primary degenerative disease of the conducting
system (Lenegre’s, Lev’s disease)
• Congenital heart disease
• Hyperkalaemia (resolves with treatment)
26. Brugada syndrome
Burns E. Brugada syndrome (April 8, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/brugada-syndrome/
27. Brugada syndrome
Brugada sign must be
associated with one of the
following clinical criteria:
Brugada sign
Coved ST segment elevation
>2 mm in V1-V3 followed by a
negative T wave.
documented VF or polymorphic VT, family
history of sudden cardiac death at <45
years old, coved-type ECGs in family
members, inducibility of VT with
programmed electrical stimulation,
syncope, nocturnal agonal respiration
Treatment
The only proven therapy is
an implantable cardioverter-
defibrillator (ICD)!
High incidence
of sudden death
in patients with
structurally
normal hearts!
Type 1:
classic
Brugada sign
Type 2: >2mm
of saddleback
shaped ST
elevation
Type 3: <2mm
of ST segment
elevation