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Very abnormal T waves in a 37-year-old man
  1. Mark E Willcox,
  2. Peter J Kudenchuk,
  3. Jordan M Prutkin
  1. Division of Cardiology, Section of Cardiac Electrophysiology, University of Washington Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr Jordan M Prutkin, Division of Cardiology, Department of Medicine, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98195, USA; jprutkin{at}cardiology.washington.edu

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Clinical introduction

A 37-year-old man presents after a syncopal event. He has schizophrenia and bipolar disorder, for which, risperidone was recently started. On arrival, heart rate and blood pressure were normal, potassium was 3.2 meq/dL (0.82 mmol/L), magnesium was 2.5 meq/dL (1.1 mmol/L), calcium was 8.7 mg/dL (2.2 mmol/L) and cardiac biomarkers were normal. Bedside echocardiogram showed grossly normal LV systolic function. His presenting ECG is shown in figure 1.

Figure 1

Presenting ECG in the emergency department.

Question

Which finding is seen on this ECG, and what is the likely subsequent clinical scenario?

  1. Hyperacute T waves—early ST …

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