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Every second counts: giant ECG abnormality after every second beat
  1. János Tomcsányi,
  2. Péter Arányi
  1. Cardiology Department, Betegápoló Irgalmasrend Budai Irgalmasrendi Kórház, Budapest, Hungary
  1. Correspondence to Dr Péter Arányi, Cardiology Department, Betegápoló Irgalmasrend Budai Irgalmasrendi Kórház, Budapest, Budapest 1023, Hungary; aranyi.p{at}

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Clinical introduction

The patient had recently been diagnosed with heart failure and dilated cardiomyopathy (left ventricular ejection fraction: 20%). Medication included furosemide, spironolactone, bisoprolol, perindopril, indapamide. The patient was found with a cardiac arrest. After successful basic life support and stabilized circulation, the following ECG was recorded (see figure 1).

Figure 1

Twelve-lead ECG on hospital admission. In the precordial leads, every second beat is followed by a giant negative T wave with apparent notches on the descending slopes.


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  • Contributors JT: patient treatment, case presentation, idea and manuscript preparation. PA: manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.