Approach

Weekly Workout August 10, 2026

UMMC Cases Part II: Grouped Beats, Slow VT, and Diffuse ST Elevation

A 63-year-old man presents with shortness of breath. His ECG shows an unusual rhythm with repetitive groups of two beats separated by pauses.

ECG STAT August 3, 2026

Inverted P Waves in V1: DDx

Key Points: Know What Is Normal: The sinus P wave in V1 is often biphasic, with an initial positive and terminal negative component. A predominantly or completely negative P wave…

Weekly Workout July 27, 2026

ECG Hallucinations: The Rhythms You See and the Rhythms You Miss

A patient presents with a regular narrow-complex tachycardia. The computerized interpretation identifies sinus tachycardia, and the rhythm appears superficially compatible with that diagnosis when lead II is reviewed. However, closer…

Weekly Workout July 20, 2026

ECG Hallucinations: When Irregular Is Not Atrial Fibrillation

A 69-year-old man presents with chest pain. His ECG is interpreted by the computer as atrial fibrillation, a diagnosis that could significantly alter his evaluation and long-term management. The rhythm…

Weekly Workout July 13, 2026

ECG Hallucinations: When S1Q3T3 Misleads

A 51-year-old truck driver presents to the ED after a brief syncopal episode at a rest stop. It is the middle of summer, his truck’s air conditioning is not working,…

Weekly Workout July 6, 2026

The Rhythm Behind the Irregularity

A 69-year-old woman presenting with sepsis gets the following ECG for tachycardia while febrile and shivering. The baseline is poor, atrial activity is difficult to identify, and the computer interpretation…

Weekly Workout June 29, 2026

A Closer Look at the J Point

A 72-year-old man undergoes a prehospital 12-lead ECG. The tracing appears to show ST segment elevation in leads III, aVF, and aVR, raising concern for an inferior STEMI or high-risk…

ECG STAT June 1, 2026

The Bix Rule (Unmasking Atrial Flutter)

Key Points: The Bix Rule is a bedside ECG clue for atrial flutter with 2:1 conduction. If an apparent “P wave” sits exactly halfway between 2 QRS complexes in a…

Weekly Workout May 11, 2026

Post-Arrest STEMI: Cath Lab or Caution?

A 72-year-old man is brought to the ED after witnessed cardiac arrest. Bystander CPR was started quickly, EMS found a nonshockable rhythm, epinephrine was given, and ROSC was achieved. Forty…

ECG STAT May 10, 2026

J Point: Basics

Key Points: The J point is the junction between the end of the QRS complex and the beginning of the ST segment. It is a location, not a separate waveform….

Weekly Workout May 4, 2026

A Post-Arrest ECG With a Dangerous New Bundle Branch Block

A 72-year-old man is brought to the ED after a witnessed out-of-hospital cardiac arrest. Bystander CPR is started quickly, EMS finds a non-shockable rhythm, and ROSC is achieved after one…

ECG STAT April 16, 2026

Wide QRS Complex: DDx

Key Points: A QRS duration greater than 120 ms reflects delayed or abnormal ventricular depolarization. A wide QRS may be chronic and benign in context, or it may be the…

Weekly Workout April 13, 2026

UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not

A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the…

ECG STAT April 11, 2026

Junctional Rhythms

Key Points: Junctional rhythms arise from the AV junction, usually the AV node or proximal His bundle, when the sinus node slows, fails, or impulses do not reach the ventricles…

Weekly Workout April 6, 2026

UMEM Cases, Part 2: When the ECG Conceals and When It Reveals

An 81-year-old woman presents with lightheadedness and marked bradycardia. Her ECG shows more P waves than QRS complexes, but the mechanism is not immediately clear. The key question is whether…

ECG STAT April 1, 2026

Heart Rhythm: Basics

Key Points: Don’t trust the ECG machines automated interpretation. Confirm the rhythm yourself. Start with the ventricles (R–R pattern), then the atria (P waves), then the AV relationship (PR behavior/P:QRS)….

ECG STAT April 1, 2026

Heart Rate: Basics

Key Points: Never accept the machine’s rate blindly. Confirm it yourself as ECG computer interpretations are frequently inaccurate. Verify paper speed and gain first (default 25 mm/s, 10 mm/mV). Name…

Weekly Workout March 23, 2026

Subtle ST Abnormalities and a Difficult Cath Lab Decision

A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer…

ECG STAT March 11, 2026

Stepwise Approach to STAT ECGs Hub

Key Points: Use a consistent ECG routine. In acute care, a repeatable approach reduces misses and helps you recognize dangerous patterns faster. Prioritize life threats first. Instability, malignant rhythms, occlusion…

Weekly Workout February 23, 2026

Preexcitation Pitfalls (Part 3): Wide, Irregular, Fast…Avoid AV Nodal Blockers

A 53-year-old man presents with palpitations and lightheadedness. The following ECG is obtained on arrival and appears very rapid and irregular with changing QRS morphologies. He starts showing signs of…

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