An unusual cause of giant T waves.

In the acute care setting, the two most common causes of giant upright T waves include hyperkalemia and the very early phase of acute myocardial infarction (MI). The former is characterized by narrow based and peaked T waves. The giant T waves of early MI, also called "hyperacute T waves," are usually more broad-based.

Common ECG interpretation software mistakes Part III: Computer errors that should never be missed.

Electrocardiogram interpretation software mistakes can lead to incorrect diagnoses and inappropriate treatments. Occasionally, the consequences of not recognizing such mistakes are disastrous. This final chapter on software mistakes describes three relatively common computer errors that should never be missed because not recognizing them can result in stroke, cardiac arrest, and even death.

Common ECG interpretation software mistakes. Part I: False reporting of myocardial infarction.

The purpose of computerized analysis of electrocardiograms (ECGs) is to provide rapid interpretation in places where ECG experts are not available, and to save physician time for all providers. For the most part, contemporary interpretation algorithms perform remarkably well and offer correct diagnoses of common ECG abnormalities. Diagnostic accuracy for myocardial ischemia and infarction is reasonably good but with these conditions, false positive and false negative readings can be disastrous.

Precordial ST-segment continuum: A variant of the de Winter sign.

The vast majority of patients with acute occlusion of the proximal left anterior descending coronary artery (LAD) suffer frank ST-elevation myocardial infarction (STEMI). In contrast, a small but not insignificant minority presents with an electrocardiographic (ECG) pattern termed the "de Winter sign." The de Winter sign is characterized by upsloping ST depression followed by tall and peaked T waves in the precordial leads.