Shark fin ST elevation

Shark fin ST elevation has been suggested as a term for merged complexes including a wide QRS, slurred J-point, massive concordant ST deviation and T wave all in one blended complex. This sign looks like the fin of a shark. It is also known as a ‘Giant R-wave”. Its incidence is unknown. It is associated with acute coronary occlusion and has a poor prognosis.

This sign can be mistaken for a very wide QRS alone, as the end of the QRS can be hard to distinguish when it blends in to the ST segment so easily. Using multiple leads may make it easier to find the end of the QRS complex.

See also: ST segment

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References

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Bradycardia Normal Axis Regular Anterior ST elevation Inferior ST elevation Lateral ST elevation Shark fin ST elevation Widespread ST elevation Left main occlusion 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 40 min later with crushing chest pain

This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG 40 min after arrival when he had a sudden recurrence of crushing chest pain and appeared critically ill.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Bradycardia Electrode Detachment Normal Axis Regular Anterior ST elevation Inferior ST elevation Lateral ST elevation Shark fin ST elevation Widespread ST elevation Left main occlusion 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 41 min later with crushing chest pain, just before arrest

This ECG is from a man in his 50s who presented with chest pain radiating to the left side and back, nausea, diaphoresis and bilateral finger tingling sensation. This was the repeat ECG about 41 min after arrival, with recurrent crushing chest pain, just before he arrested.

In the ECGquest archives, this ECG has been tagged with: - Shark fin ST elevation 12-Lead Dr Smith's ECG Blog CC BY-NC
“Shark fin” ECG in I, aVL, V4 and V5. Which artery? Hint: patient is in shock and was put on ECMO