Approach

ECG STAT April 20, 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

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…

ECG STAT March 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 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…

Weekly Workout February 16, 2026

Preexcitation Pitfalls (Part 2): Wide, Regular, Fast…Treat It Like VT

A young man with recurrent palpitations presents to the emergency department hemodynamically stable during an episode. The arrival ECG shows a wide complex, regular tachycardia and the computer interpretation calls…

ECG STAT February 14, 2026

Appropriate Discordance

Key Points: Appropriate discordance refers to the expected secondary ST segment and T wave pattern seen with abnormal ventricular depolarization, especially LBBB and ventricular-paced rhythm. The ST segment and T…

ECG STAT February 12, 2026

QRS Morphology and ST-T Interpretation: Basics

Key Points: Read the QRS before you read the ST segment or T wave. Ventricular depolarization shapes repolarization. Narrow QRS usually reflects normal His-Purkinje conduction. Wide QRS suggests abnormal ventricular…

Weekly Workout February 9, 2026

Preexcitation Pitfalls (Part 1): The “Inferior STEMI” That Isn’t

A critically ill 38-year-old man presents hypotensive, pale, and diaphoretic with abdominal pain and rectal bleeding. Upright chest X-ray shows free air under the diaphragm, and the patient is headed…

Weekly Workout January 19, 2026

Three More ECG Pitfalls That Punish Anchoring Bias

A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally…

Weekly Workout January 12, 2026

Four ECG Pitfalls That Punish Anchoring Bias

A 43-year-old woman with sharp left-sided chest pain and minimal cardiac risk factors has an initial ECG that is not diagnostic for STEMI. She looks stable, but one feature on…

ECG STAT January 7, 2026

Waveforms, Segments, & Intervals: Basics

Key Points: Every ECG tracing is built from waveforms (deflections), segments (baseline portions between waveforms), and intervals (time that include waveforms plus segments). Waveforms describe electrical events (depolarization or repolarization)….

ECG STAT January 7, 2026

STAT ECG 101: The Acute Care ECG Workflow

Key Points: The ECG is the fastest bedside test for rhythm, conduction, ischemia, and tox-metabolic disease. It only saves lives when interpreted systematically and acted on. In acute care, the…

Weekly Workout January 5, 2026

Dr. Mattu’s 5 Favorite ECG Cases of 2025

A 68-year-old man presents after syncope with profound bradycardia. The ECG shows a very slow ventricular rate with high-grade AV block. The reflex move is to focus only on pacing,…

ECG STAT October 10, 2025

J Point: Basics

Key Points The J point is the junction where QRS ends and the ST segment begins. It is a location, not a waveform. ST deviation is judged at the J…

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