- Benign early repolarization shows concave ST elevation less than 2 mm with no progression over time, most prominent in V2-V5. Notching at the J-point and concordant T-waves are also seen. - Beta-blocker and calcium channel blocker toxicity can cause prolonged PR interval and bradycardia. Propranolol toxicity specifically causes QRS widening and positive R' wave in aVR. Sotalol toxicity causes QT prolongation and risk of Torsades de Pointes. - Bifascicular block is a combination of right bundle branch block with either left anterior or posterior fascicular block, and can be caused by ischemia, hypertension or other

1. ECG B
Domina Petric, MD

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/

8. Suspects are:

9. ECG features
A prolonged PR interval is an early sign of
beta-blocker or calcium-channel
blocker toxicity.

10. Bradycardia 45 bpm, PR interval 240 ms

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.

13. Bidirectional Ventricular
Tachycardia (BVT)
Burns E. Bidirectional Ventricular Tachycardia (April 8, 2017). Retrieved
from https://lifeinthefastlane.com/ecg-library/basics/bvt/

14. Causes

15. ECG features

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)

20. RBBB+LAFB
Left electrical axis
QRS≈120 ms

21. Biventricular Hypertrophy
Burns E. Biventricular Hypertrophy (April 8, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/biventricular-hypertrophy/

22. Biventricular Hypertrophy

23. Katz Wachtel phenomenon

24. Biatrial Enlargement
Burns E. Biatrial Enlargement (April 16, 2017). Retrieved from
https://lifeinthefastlane.com/ecg-library/biatrial-enlargement/

25. Biatrial Enlargement
Biatrial enlargement is diagnosed
when criteria for both right and
left atrial enlargement are present
on the same ECG.

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

28. Literature