Core
Results:
STEMI vs Wide QRS (BBBs & Paced Rhythms): DDx
Key Points: Wide QRS rhythms distort repolarization. Bundle branch block and ventricular pacing create secondary ST-T changes even without occlusion MI. Appropriate discordance is expected. ST segments and T waves…
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…
Pericardial Tamponade
Key Points: Pericardial tamponade is a hemodynamic diagnosis, not just an ECG diagnosis. ECG may show sinus tachycardia, low-voltage QRS, and sometimes electrical alternans, but none are sensitive enough to…
Modified Sgarbossa Criteria: STEMI Equivalent Pattern
Key Points: LBBB and ventricular-paced rhythms can hide acute coronary occlusion because abnormal depolarization creates expected secondary ST-T changes. Occlusion MI can still be recognized when those ST changes are…
Isorhythmic AV Dissociation
Key Points: Isorhythmic AV dissociation is a form of AV dissociation in which the sinus rate and junctional or ventricular escape rate are nearly identical, making the P waves and…
Third-Degree AV Block (Complete Heart Block)
Key Points: Third-degree AV block is complete failure of atrial impulses to conduct to the ventricles. The defining ECG feature is AV dissociation with no conducted P waves. The atrial…
Second-Degree AV Block Type I (Mobitz I/Wenckebach)
Key Points: Mobitz I is defined by progressive PR prolongation until a single P wave fails to conduct, after which the cycle resets. The block is usually at the AV…
Second-Degree AV Block with 2:1 Conduction
Key Points: Second-degree AV block with 2:1 conduction means every other P wave conducts and every other P wave is blocked. A single ECG with 2:1 conduction usually cannot be…
Second-Degree AV Block Type II (Mobitz II)
Key Points: Mobitz II is defined by sudden failure of AV conduction after at least 2 consecutive conducted beats with fixed PR intervals and no preceding PR prolongation. The block…
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…
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