Core
Results:
STEMI vs Severe Hyperkalemia: DDx
Key Points: Severe hyperkalemia is a true ECG chameleon. It can produce ST elevation, wide QRS complexes, axis shifts, and conduction blocks that closely mimic STEMI or ventricular tachycardia. New…
STEMI vs Acute Pericarditis: DDx
Key Points: Start by looking for STEMI, not pericarditis. The safest workflow is to actively search for occlusion MI features first, then use pericarditis features as supportive evidence. Reciprocal ST…
Traditional STEMI Criteria
Key Points: STAT ECG is the first decision point in ACS. The primary purpose of the initial ECG is to identify patients who meet traditional STEMI criteria and require immediate…
ST Depression V1-V4: OMI Pattern
Key Points: Most missed occlusion MI. Isolated posterior occlusion MI is frequently missed because the standard 12-lead ECG often lacks ST elevation. Instead, posterior injury appears as reciprocal anterior ST…
STEMI vs Takotsubo Cardiomyopathy: DDx
Key Points: Takotsubo (stress) cardiomyopathy is a transient, non-ischemic LV dysfunction—classically apical ballooning with basal hyperkinesis—often after emotional or physical stress. Presentation mimics occlusion MI (chest pain, ECG changes, elevated…
Earliest Evidence of Occlusion MI
Key Points: ACS is dynamic. Coronary arteries can occlude, partially reperfuse, and re-occlude over minutes to hours, and the ECG can show these shifts before biomarkers do. The earliest actionable…
ECG Evidence of Reperfusion After Occlusion
Key Points Reperfusion and re-occlusion can occur spontaneously or after therapy. The ECG often reflects these changes earlier than symptoms. Most useful bedside ECG marker of reperfusion is ST-segment resolution…
Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Acute Coronary Syndromes (ACS)
Key Points: ACS is a clinical syndrome: classified by ischemic symptoms + ECG + troponin. ACS exists on a continuum of unstable angina, NSTEMI, STEMI, and patients can evolve between…
Hypomagnesemia
Key Points: Hypomagnesemia is an important arrhythmogenic electrolyte abnormality. It increases risk of atrial and ventricular ectopy, ventricular tachycardia, and torsades de pointes, especially when QT is prolonged. The most…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition & Terminology: Arrhythmogenic Cardiomyopathy (ACM), previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly…
de Winter T Waves: STEMI Equivalent Pattern
Key Points: STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). Treat the…
Pacemakers: Basics
Key Points: Pacemakers treat bradyarrhythmias by delivering timed atrial, ventricular, or dual-chamber pacing when intrinsic activity is slow or absent. Know the major device types encountered in the ED: single-chamber,…
High-Risk Pulmonary Embolism
Key Points: The ECG can provide early clues to high-risk PE and may identify patients at risk for rapid hemodynamic collapse. Right ventricular strain patterns are the core high-risk markers….
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
Himalayan T Waves
Key Points Tall, broad-based T–U fusion that looks like a mountain peak, usually from severe hypokalemia; think high torsades risk until proven otherwise. Hallmark is prolonged repolarization: QT appears long…
Pseudo-Wellens Waves
Key Points: Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Wellens Waves
Key Points Wellens waves are anterior precordial T wave abnormalities (biphasic or deeply inverted) most often in V2–V3, occasionally extending to V1 and V4–V6. They signal a high likelihood of…
Wellens Syndrome
Key Points Wellens waves are anterior precordial T wave abnormalities (biphasic or deeply inverted) most often in V2–V3, occasionally extending to V1 and V4–V6. They signal a high likelihood of…
Ventricular Tachycardia (VT): Core Overview
Key Points: VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
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