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.

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Shark fin ST elevation LAFB RBBB Proximal LAD occlusion Dr Smith's ECG Blog CC BY-NC
Shark Fin morphology recognized only by EM physician 31940

This ECG is from a man in his 70s who complained of acute chest pain followed by a witnessed cardiac arrest. This ECG was taken after ROSC following 35 min down time.

This ECG shows Shark-fin morphology with RBBB + LAFB and massive anterolateral ST elevation. The cause was an acute proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 40 min later with crushing chest pain 26740

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 12-Lead Electrode Detachment Serial 12-lead Anterior ST elevation Bradycardia Inferior ST elevation Lateral ST elevation Normal Axis Regular Shark fin ST elevation Widespread ST elevation Left main occlusion Dr Smith's ECG Blog CC BY-NC
Total eclipse of the heart – 41 min later with crushing chest pain, just before arrest 26743

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: - 12-Lead Shark fin ST elevation 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 10150
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Shark fin ST elevation Dr Smith's ECG Blog CC BY-NC
Giant R-waves. What are they? 10698