Core
Results:
Electrical Storm
Key Points Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
Pulseless Electrical Activity (PEA) Arrest
Key Points Definition: Organized electrical activity on ECG without a palpable pulse. PEA is a non-shockable arrest rhythm requiring CPR, epinephrine, and identification of reversible causes. Confirmation: Verify in two…
Asystole (Cardiac Arrest)
Key Points Definition: Asystole is a non-shockable cardiac arrest rhythm characterized by absence of ventricular electrical activity. Treat with high-quality CPR, epinephrine every 3–5 minutes, and an urgent search for…
Ventricular Fibrillation (VF) Arrest
Key Points Defibrillation First, Minimal Pauses: VF is rapidly fatal without immediate shocks and high‑quality CPR. Charge during compressions and resume compressions immediately after each shock. Chaotic Electrical Activity: VF…
Ventricular Flutter (V-Flutter)
Key Points Definition: A malignant ventricular tachyarrhythmia with a regular, sine-wave–like waveform at ~250–350 bpm, no isoelectric baseline, and no discernible P/QRS/T distinction. Clinical importance: Rapidly degenerates into ventricular fibrillation…
Post-Cardiac Arrest ECGs
Key Points Early post-ROSC ECGs often mislead. Within the first 8–10 minutes, transient global ischemia and catecholamines can exaggerate ST changes. Plan a repeat at 10–15 minutes before making cath…
Unstable Bradyarrhythmias
Key Points: Unstable bradyarrhythmias cause poor perfusion which can rapidly progress to shock, irreversible organ injury, or cardiac arrest. Priority: Do not treat the heart rate alone — treat clinical…
Unstable Tachyarrhythmias
Key Points: Intervene Immediately: Unstable tachyarrhythmias pose significant risk for rapid clinical deterioration that may lead to irreversible end-organ damage or cardiac arrest. Clinical Indicators of Instability: Altered Mental Status:…
Premature Junctional Complexes (PJCs)
Key Points PJCs are premature impulses from ectopic foci in or near the AV junction. ECG hallmark is a narrow premature beat with an absent or retrograde P wave. Retrograde…
J Point: Basics
Key Points The J point is the junction where QRS ends and the ST segment begins. It is a location, not a waveform. ST deviation is judged at the J…
J Wave: Basics
Key Points Definitions: The J point is the QRS–ST junction (a location). A J wave is an added deflection at or just after that point (notch or slur). Why it…
Severe Hypothermia
Key Points Severe hypothermia causes rate- and temperature-dependent ECG changes that signal high arrhythmia risk. Recognition guides safe rewarming and prevents iatrogenic VF. Osborn (J) waves may appear and typically…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
Proper ECG Electrode Placement
Key Points A diagnostic 12‑lead ECG is only as good as your electrode placement. Misplacement can mimic MI, BBB, or poor R‑wave progression and trigger unnecessary workups. A standard 12‑lead…
Cannabis (Marijuana) Toxicity
Key Point Cannabis use is rising across recreational and medical contexts. Causation is not proven, but multiple contemporary studies associate cannabis with acute cardiovascular events, including MI, stroke, arrhythmias, and…
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Key Points Definition and mechanics: Genetic hypertrophic cardiomyopathy with asymmetric LV hypertrophy, typically septal, causing dynamic LVOT obstruction from systolic anterior motion (SAM) of the mitral valve. Gradient worsens when…
Yamaguchi Pattern: Apical Hypertrophic Cardiomyopathy (ApHCM)
Key Points Definition and mechanics: Hypertrophic cardiomyopathy variant with maximal hypertrophy at the LV apex (apical HCM, ApHCM). LVOT is often not obstructed at rest; some patients have mid-ventricular obstruction…
Syncope Emergencies
Key Points: ECG and monitor early: First-time seizure, near-syncope, unexplained LOC, or syncope all get a 12-lead now and continuous telemetry. Repeat ECG during symptoms or after another event. History…
Accelerated Idioventricular Rhythm (AIVR)
Key Points: Definition: AIVR is a transient, usually benign ventricular rhythm often seen after reperfusion of an acute myocardial infarction (AMI), whether spontaneous or post-intervention (PCI or thrombolysis). Rate Differentiation:…
Must-Know Syncope: DDx
Key Points: Syncope and the ECG: Syncope is a transient loss of consciousness and postural tone, characterized by rapid onset, brief duration, and spontaneous recovery without medical intervention. Cardiac syncope…
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