Identify the ECG pattern shown in the image below.

Appeared in: NORCET-11 Prelims

Explanation

Brugada Type 2 shows a saddleback-shaped ST-segment elevation in V1-V2.
The pattern is defined by an initial R wave, elevated ST segment, descent, and then a second rise (saddleback).
No coved ST elevation or deep negative T wave is present, distinguishing it from Type 1.
Correct identification is critical for risk stratification and management.

Option A: Brugada Type 1 shows a coved ST-segment elevation with a negative T wave in V1-V2, not a saddleback pattern.
Option C: Brugada Type 3 has either a saddleback or coved pattern but with less than 2 mm of ST elevation, making it less specific.
Option D: Wellens Type A is associated with deep T-wave inversions or biphasic T waves in V2-V3, seen in critical LAD stenosis, not a saddleback ST elevation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of Brugada syndrome ECG patterns, specifically Type 2 (saddleback morphology) as background academic context rather than a clinical decision trigger.
Early identification of Brugada Type 2 can help prevent sudden cardiac death in at-risk individuals.
Nurses should monitor for arrhythmias and educate patients about avoiding fever and certain medications that can unmask Brugada patterns.
What if? If the ECG showed a coved ST elevation with a negative T wave, the diagnosis would shift to Brugada Type 1, which carries a higher risk of arrhythmia.

How to Approach the Question

Carefully observe the ST-segment morphology in the right precordial leads (V1-V2).
Identify whether the elevation is coved or saddleback in shape.
Recall the distinguishing features of Brugada Types 1, 2, and 3.
Eliminate options that do not match the visual pattern.
Use clinical context and pattern recognition to select the best answer.

Concept Tested & Keywords

Concept Tested: Recognition of Brugada syndrome ECG patterns, specifically Type 2 (saddleback morphology)
Stem keywords: ECG pattern, Brugada syndrome, ST-segment elevation, right precordial leads
Lead-in keywords: Identify
Clinical cues: Saddleback ST elevation in V1-V2

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E6 Medicine Harrison 22e Part 1 p. 2011-2013

Practise the full NORCET-11 Prelims

Attempt every question from this paper in a timed mock, then review the full solution for each one.