Core
Results:
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…
UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135….
Junctional Tachycardia
Key Points: Junctional tachycardia is an uncommon supraventricular tachycardia arising from the AV junction, usually due to enhanced automaticity rather than reentry. It is usually a regular narrow-complex tachycardia, although…
Dysrhythmias in LVAD Patients
Key Points: Continuous-flow LVADs can mask cardiovascular collapse. Patients may remain awake during sustained VT or even VF because the pump can provide temporary flow. Treat the rhythm and the…
Severe Hypothermia
Key Points: Severe hypothermia causes predictable ECG slowing and conduction delay. Sinus bradycardia, PR/QRS/QT prolongation, and atrial fibrillation with a slow ventricular response are common as core temperature falls. Osborn…
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)….
Normal STAT ECGs
Key Points: Clinical Context: A single normal 12-lead ECG in the emergent setting does not exclude all life-threatening conditions such as early occlusion MI/ACS, PE, tamponade, or aortic catastrophe. Do…
Computer Interpreted “Normal” ECGs
Key Points: Do not trust a computer read of “normal” without your own review. Computer interpretation is especially unreliable for subtle or early ischemia, including hyperacute T waves, minimal ST…
Abnormal STAT ECGs
Key Points: Clinical Context: Abnormal ECGs must be interpreted within the patient’s presentation. Not all abnormalities are life-threatening, and high-risk conditions can still appear subtle or even “normal.” Serial Monitoring:…
South African Flag Sign: OMI Pattern
Key Points: Pattern: The South African Flag sign is the combination of ST elevation in I, aVL, and V2 with reciprocal ST depression in III. It is a subtle but…
Pacemaker Syndrome
Key Points: Pacemaker syndrome is a hemodynamic problem caused by loss of proper atrioventricular (AV) synchrony. Most commonly occurs with ventricular pacing that produces retrograde atrial activation, but can also…
Right Atrial Enlargement (RAE)
Key Points: RAE reflects increased right atrial size or pressure load and is usually a marker of underlying pulmonary or right-sided cardiac disease. The classic ECG clue is a tall,…
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…
The Life Savers: Critical ECGs Hub
Key Points: Life Savers are the can’t-miss ECGs. These patterns may reflect immediately life-threatening ischemic, electrical, mechanical, obstructive, toxicologic, or metabolic emergencies. This hub is built for rapid action. Use…
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 Basics & Fundamentals Hub
Key Points: This hub organizes ECG basics and fundamentals into three complementary “start here” pathways: ECG definitions and measurement, how ECGs work and are generated, and the acute care STAT…
Occlusion MI in Left Bundle Branch Block (LBBB): STEMI Equivalent Pattern
Key Points: LBBB does not exclude acute coronary occlusion. LBBB produces abnormal depolarization and expected secondary ST-T changes, which can mask or mimic ischemia. Acute OMI can still be recognized…
Electrical Alternans
Key Points: Electrical alternans is a beat-to-beat alternation in QRS amplitude, axis, or both. It is classically associated with a large pericardial effusion and may support concern for tamponade, but…
Pericardial Effusion
Key Points: Pericardial effusion is the accumulation of fluid in the pericardial sac. ECG may provide clues, but it is not sensitive enough to exclude effusion. Important ECG clues include…
STEMI vs LVH: DDx
Key Points: Left ventricular hypertrophy (LVH) with strain is one of the most common and dangerous STEMI mimics, particularly in the anterior leads, and is a frequent cause of false-positive…
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