Reading the ECG: The ST Segment and the T Wave

What this deck covers

Reading the ECG: The ST Segment and the T Wave in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Where the segment is measured from
2. T waves that ought to be upside down
3. Elevation in a well adolescent
4. Elevation almost everywhere
5. Complexes that shrink and sway
6. Depression where the muscle is thick
7. An infant who cries and goes pale
8. T waves you could cut yourself on
9. Change in two leads and nowhere else
10. Inversion in the wrong half of the chest
11. A segment with a distinctive sag
12. The most useful test is already on file

What this deck teaches

• The J point, against the T to P line. Deviation is measured at or just after the J point and judged against the baseline between the end of the T wave and the next P wave.
• Inverted on the right is the childhood pattern. T waves invert in the right chest leads within the first week and stay inverted through childhood. Inversion in the LEFT chest leads is never a variant.
• Shape and stability, not height. A notched J point with smoothly concave elevation, unchanged over years, in a young athletic person, is a normal variant.
• Which leads are involved is most of the meaning. One coronary territory means one thing; nearly every lead, with the PR segment depressed as well, means something involving the whole surface.
• Small complexes that alternate in height. Two signs sitting together, and both are read alongside quiet heart sounds and a pulse that falls with inspiration.
• Changes face what they belong to. Strain sits in the leads facing the thick ventricle, beside the tall R waves. Deep broad Q waves in an unwell infant face damaged muscle.

Exam pearls from this deck

• The J point is where the measurement starts, not the middle of the segment.
• Inverted on the right is normal in a child. Inverted on the left is not.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all cardiology illustrated case decks · cardiology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.