Artifact
Results:
Pulse-Tapping Artifact
Key Points Mechanical artifact caused by an ECG electrode sitting on top of a strong arterial pulse. Seen frequently in dialysis patients with AV fistulas. Can mimic serious pathology including…
Pseudo-Wellens Waves
Key Points Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Artifact vs Ventricular Rhythms: DDx
Key Points Artifact is a common source of misdiagnosis for serious arrhythmias such as polymorphic ventricular tachycardia (PVT), torsades de pointes, or ventricular fibrillation (VF). Always correlate the ECG findings…
Artifact vs STEMI: DDx
Key Points Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
Understanding ECG Artifacts
Key Points Artifacts = non-cardiac signals that distort or obscure true ECG. They come from the patient, leads/equipment, or the environment. Clues to artifact: lacks a physiologic pattern, varies beat-to-beat…
WPW Syndrome and Pseudo-MI Patterns
Key Points WPW Pattern Mimics: Wolff-Parkinson-White (WPW) syndrome can produce an ECG pattern that mimics conditions such as myocardial infarction, ventricular bigeminy, accelerated idioventricular rhythm, and electrical alternans. ST Segment…
When One Lead Stands Alone: Deciphering Bizarre ECG Abnormalities
A 67-year-old woman with PMHx of HTN, DM, and ESRD presents to the emergency department drowsy and non-cooperative. Her blood sugar is elevated, pH 7.23, and there is concern for…
Subtle ECG Changes and Diagnostic Challenges
A 70-year-old male presents to the emergency department with acute chest pain that sounds ischemic in nature. The following baseline ECG, arrival ECG, and repeat ECGs are obtained:
Shock first and ask questions later?
An elderly woman with a past medical history of hypertension, diabetes, and Parkinson’s disease presents to the ED with hip pain after a fall. Her blood pressure and mental status…
2024 EMS Cases Part I
A 64-year-old man is being brought in by EMS for chest pain and shortness of breath. The following EMS ECG is obtained:
Wide Complex Tachycardias: distinguishing malignant arrhythmias from their mimics
A 65-year-old woman with PMHx of Parkinson’s disease presents to the emergency department after an episode of syncope. She continues to feel unwell on arrival and appears diaphoretic, blood pressure…
Rhythm interpretation: when to worry about cardiac rhythm strips
A 55-year-old woman with PMHx of CHF presents to an urgent care facility with shortness of breath, orthopnea, and weight gain after running out of her diuretics for the past…
ECG Basics and Fundamentals: a condition that is commonly misdiagnosed at polymorphic ventricular tachycardia (PMVT), torsades de pointes, and ventricular fibrillation
A 55-year-old woman presents to the ED with mild to moderate COVID pneumonia. She reportedly had a syncopal episode while on a bed pan. The following rhythm strip was obtained…
STAT ECG Diagnoses: getting rhythm strips right and knowing when acute intervention is needed
A 66-year-old man is transferred to the ED from an urgent care where he presented for shortness of breath and was diagnosed with heart failure. He was recently discharged s/p…
ECG Basics & Fundamentals: how common is artifact?
A 72-year-old man presents to the ED with near-syncope. During his evaluation he has a 20-second run of the following rhythm captured on 12-lead ECG monitoring:
A specific tachyarrhythmia with an excellent prognosis
A 79-year-old man presents to the ED with intermittent episodes of decreased level of consciousness. He is placed on continuous 12-lead cardiac monitoring during his evaluation and a monitor alarm…
Rhythm Interpretation: the importance of patient assessment in managing malignant arrhythmias
A 74-year-old woman presents to the ED with shortness of breath. She has been taking azithromycin for cough. The following ECG is obtained:
2016 ECG Competition Answers (Part 1/2)
This week we review the answers to the first 6 cases from the 4th annual UMEM Residency ECG Competition. Make sure to attempt to answer the questions before you watch the video! Video…
ECG findings in hypothermia
A 77-year-old male is brought into the ED after being found unconscious in his home. The following prehospital ECG was obtained and compared to an old normal ECG:
STAT ECG Diagnoses: how would this prehospital rhythm strip change your management?
A 10-year-old male is transported to your ED for recurrent seizures. The following prehospital rhythm strip was obtained:
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