Arrhythmia
Results:
Polymorphic Ventricular Tachycardia (PMVT)
Key Points: Definition: Polymorphic ventricular tachycardia is VT with beat-to-beat variation in QRS morphology, axis, and amplitude. Clinical significance: PMVT is electrically unstable and can rapidly deteriorate into ventricular fibrillation…
Nonsustained Ventricular Tachycardia (NSVT)
Key Points: Definition: Nonsustained ventricular tachycardia is 3 or more consecutive ventricular beats lasting less than 30 seconds and terminating spontaneously. Rate: VT is usually faster than 120 bpm, but…
Occlusion MI in Ventricular Paced Rhythms: STEMI Equivalent Pattern
Key Points: Ventricular paced rhythms can mask acute coronary occlusion. Pacing alters depolarization and produces expected secondary ST-T abnormalities, so standard STEMI criteria are unreliable. Appropriate discordance is expected in…
Preexcitation Pitfalls (Part 4): Potpourri Cases & Final Teaching Points
A 49-year-old man arrives with palpitations and chest discomfort. The monitor shows an irregular, wide-complex tachycardia with varying morphology and rates nearing 250 to 300 bpm. The team debates polymorphic…
Atrial Flutter with Variable Conduction
Key Points: Mechanism: Typical atrial flutter arises from a large re-entry circuit in the right atrium. The atrial rate is usually near 300 beats per minute. ECG hallmark: Continuous “saw-tooth”…
Atrial Flutter 2:1 Conduction
Key Points: Atrial flutter is a macro-reentrant atrial tachycardia, most commonly typical cavotricuspid isthmus-dependent right atrial flutter, with an atrial rate usually near 300 bpm. With 2:1 AV conduction, the…
Atrial Flutter 1:1 Conduction
Key Points: Rare, high-risk rhythm. Atrial flutter with 1:1 conduction can produce ventricular rates of 240-320 bpm and may rapidly cause hypotension, ischemia, or collapse. Often mimics VT. The QRS…
Flutter Waves (F waves): Basics
Key Points: Flutter waves are caused by a macro-reentrant atrial circuit, most often typical right atrial flutter. Atrial rate is usually ~250-350 bpm, classically near 300 bpm. ECG shows continuous…
Atrial Flutter
Key Points: Flutter waves are caused by a macro-reentrant atrial circuit, most often typical right atrial flutter. Atrial rate is usually ~250-350 bpm, classically near 300 bpm. ECG shows continuous…
Wolff-Parkinson White (WPW) Syndrome
Key Points: Pattern vs syndrome: WPW pattern is ECG evidence of pre-excitation without symptoms. WPW syndrome is pattern plus symptomatic tachyarrhythmia (palpitations, syncope, “seizure”, aborted sudden cardiac arrest). PR interval…
WPW Syndrome and Pseudo-MI Patterns
Key Points: WPW alters ventricular depolarization, producing secondary repolarization abnormalities that can mimic or mask myocardial infarction. ST-segment deviation in WPW is often non-ischemic, driven by abnormal activation via the…
Atrial Fibrillation with WPW (Pre-excited AF)
Key Points: Pre-excited AF is the most dangerous WPW rhythm. It can deteriorate quickly to VF because the accessory pathway may conduct atrial impulses to the ventricle at extreme rates….
WPW with Antidromic SVT (Antidromic AVRT)
Key Points: Antidromic AVRT is an AV re-entrant tachycardia that conducts antegrade down the accessory pathway and returns retrograde through the AV node (or another pathway), producing a regular wide-complex…
WPW with Orthodromic SVT (Orthodromic AVRT)
Key Points: Orthodromic AVRT is the most common tachyarrhythmia in WPW and presents as a regular narrow-complex SVT that is indistinguishable from AVNRT during the tachycardia. Mechanism: antegrade conduction down…
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 1)
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The…
Bidirectional Ventricular Tachycardia (BiVT)
Key Points: BiVT is a regular wide-complex tachycardia with strict beat-to-beat alternation of QRS axis and/or bundle-branch pattern (often an approximately 180° frontal-plane axis flip). In adults, assume digoxin toxicity…
Atrial Parasystole
Key Points: Atrial parasystole is a rare atrial rhythm in which an ectopic atrial focus fires at its own intrinsic rate, relatively protected from sinus-node reset by entrance block. The…
Ventricular Tachycardia (VT): Core Overview
Key Points: VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
Pulseless Ventricular Tachycardia (pVT) Arrest
Key Points: Defibrillation First, Minimal Pauses: pVT is rapidly fatal without immediate shocks and high‑quality CPR. Charge defibrillator during compressions and resume compressions immediately after each shock. pVT is a…
Electrical Storm
Key Points: Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
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