Core
Results:
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…
Torsade de Pointes (TdP)
Key Points: Definition: Torsade de pointes is a specific subtype of polymorphic ventricular tachycardia that occurs in the setting of QT prolongation. ECG pattern: TdP shows beat-to-beat variation in QRS…
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:…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points: Pattern, not a STEMI equivalent. ST elevation in aVR (≥1 mm), often with ST elevation in V1 and diffuse ST depression (≥1 mm in ≥6 leads), represents high-risk…
Hyperkalemia Emergencies
Key Points: Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Severe hyperkalemia is one of the most dangerous ECG mimics in emergency medicine. It can resemble unstable bradyarrhythmias, VT, STEMI, and pacemaker…
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…
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…
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…
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