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When a Seizure Isn’t a Seizure: Why Every First Seizure Needs an ECG
A 34-year-old woman presents after her third witnessed episode of generalized shaking. She has already been hospitalized, undergone an unrevealing workup, and started on levetiracetam. There is one unusual feature:…
Acute Coronary Syndromes (ACS)
Key Points: ACS Is a Clinical Syndrome: Acute coronary syndrome (ACS) includes unstable angina (UA) and acute myocardial infarction (MI) caused by a primary acute coronary pathology. Diagnosis integrates symptoms…
Traditional STEMI Criteria
Key Points: STAT ECG Is the First Decision Point in Suspected ACS: The immediate purpose of the initial ECG is to identify acute coronary ischemia, particularly STEMI or another pattern…
Q Wave: Basics
Key Points: Definition and Measurement: A Q wave is the first negative deflection of the QRS complex. Measure duration from QRS onset until the waveform returns to baseline and depth…
Occlusion MI: STEMI & Beyond Hub
Key Points: The ECG’s Primary Role in ACS Is Detecting Acute Coronary Occlusion: Acute coronary occlusion is a time-critical diagnosis in which rapid recognition and reperfusion can preserve myocardium and…
EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points: Get the ECG Early: Obtain and interpret a high-quality 12-lead ECG within 10 minutes of first medical contact (FMC) in patients with suspected ACS. Early prehospital ECG acquisition…
Must-Know Syncope: DDx
Key Points: Syncope and the ECG: Syncope is a transient loss of consciousness caused by transient global cerebral hypoperfusion, with rapid onset, brief duration, and spontaneous complete recovery. Cardiac syncope…
Monomorphic Ventricular Tachycardia (MMVT)
Key Points Definition: Monomorphic ventricular tachycardia is a ventricular rhythm with a wide QRS and a single, uniform QRS morphology throughout the run. Sustained VT: VT is sustained when it…
Syncope & “Seizure” Emergencies
Key Points: ECG Early: Obtain a 12-lead ECG early in patients with unexplained syncope or seizures. Patients with suspected cardiac or arrhythmic syncope should also receive continuous cardiac monitoring. Repeat…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition: Arrhythmogenic cardiomyopathy (ACM), historically called arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), is an inherited myocardial disease characterized by progressive myocardial injury and fibrous replacement, with or without fatty…
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.
Hypokalemia
Key Points: Hypokalemia delays ventricular repolarization, producing progressive changes in the T-U complex before serious arrhythmias develop. ECG progression: T-wave flattening → mild ST depression → prominent U waves →…
Hypokalemia Emergencies
Key Points: Severe hypokalemia can result in an arrhythmia emergency. The major threat is ventricular tachyarrhythmias, including torsades de pointes, polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Severe…
Hypermagnesemia
Key Points: Hypermagnesemia is uncommon and usually occurs when impaired renal magnesium clearance is combined with increased magnesium exposure, such as magnesium-containing laxatives, antacids, bowel preparations, or therapeutic magnesium administration….
Hypomagnesemia
Key Points: Hypomagnesemia is an important arrhythmogenic electrolyte abnormality. It can promote atrial and ventricular ectopy and increase susceptibility to ventricular arrhythmias, particularly when other repolarization abnormalities are present. ECG…
Hypocalcemia
Key Points: ECG hallmark: QT prolongation caused predominantly by ST-segment prolongation, usually with relatively preserved T-wave morphology. Arrhythmia risk: Severe hypocalcemia can predispose to ventricular arrhythmias, including torsades de pointes…
Severe Hypothermia
Key Points: Severe hypothermia produces progressive electrical slowing. Sinus bradycardia, PR prolongation, QRS widening, QT prolongation, and atrial fibrillation with a slow ventricular response become increasingly common as core temperature…
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…
Slow Ventricular Tachycardia (VT)
Key Points: Definition: Slow VT refers to ventricular tachycardia occurring at an unusually low ventricular rate, often near or even below the conventional tachycardia threshold. There is no universally accepted…
Ventricular Tachycardia (VT) Mimics
Key Points: Default assumption: A regular wide-complex tachycardia should be considered VT until another diagnosis is more likely. Rate modifies the differential, not the diagnosis. Typical monomorphic VT is often…
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