BIG T WAVES

Question 1

DDX

Answer 1

3 BAD THINGS:
Hyperkalemia
STEMI
deWinter’s

OTHER:
BER

Question 2

HYPERKALEMIA

Answer 2

T Waves are Symmetric Peaked
Consistent
Widened QRS
Prolonged PR
loss of the Ps
Bradycardia
Tachycardias, AV blocks, sinus pause
Consider STEMI

Question 3

EARLY STEMI

Answer 3

T Waves are Asymmetric Round
Dynamic Changes
ECG in acute STEMI evolves quickly
Consider Hyper K+

Question 4

deWINTER’S

Answer 4

T Waves are large, peaked, together with STD
Criteria:
Tall symmetric peaked T waves in V1-6
WITH
Upsloaping ST depression > 1 mm at the J point in V1-V6
Absence of ST elevation in the precordial leads
Reciprocal ST segment elevation (0.5mm-1mm) in aVR
Proximal LAD Occlusion
~2% of acute LAD occlusions

Question 5

BER

Answer 5

Concave STE limited to V leads
Slur, notch and high take off patterns
No Qs and no T wave inversions
Large T waves proportional to STE