Core
Results:
Artifact vs Ventricular Rhythms: DDx
Key Points Artifact is a common source of misdiagnosis for serious arrhythmias such as polymorphic ventricular tachycardia (PVT), torsades de pointes, or ventricular fibrillation (VF). Always correlate the ECG findings…
Monomorphic Ventricular Tachycardia
Key Points Monomorphic ventricular tachycardia (MMVT) is the most common sustained VT. It shows a single, uniform QRS morphology throughout. Classified as sustained if lasting > 30 seconds or associated…
Inverted U Waves
Key Points Definition: A negative deflection after the T wave (a true U wave) that is ≥0.5 mm deep in a lead where the T wave is upright. Why it…
Wide QRS Complex: DDx
Key Points A QRS duration greater than 120 ms indicates abnormal ventricular depolarization. A wide QRS can signal conditions that range from benign to immediately life-threatening. Developing a focused differential…
STEMI vs Artifact: DDx
Key Points: Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
VT vs SVT with Aberrancy: DDx
Key Points ECG alone cannot reliably distinguish VT from SVT-aberrancy in many cases. Use ECG features to rule in VT, not to exclude it. Default: treat regular WCT as VT…
RV Outflow Tract Tachycardia (RVOT VT)
Key Points Idiopathic monomorphic VT arising from the right ventricular outflow tract. Most patients have no structural heart disease; catecholamine and cAMP-mediated triggers are common. Classic ECG pattern: LBBB morphology…
Hypokalemia
Key Points: Hypokalemia slows ventricular repolarization and alters the T–U complex before it triggers arrhythmias. Progressive pattern: T-wave flattening → prominent U waves → T–U fusion with apparent QT prolongation;…
Hypokalemia Emergencies
Key Points Severe hypokalemia can produce dramatic ECG changes that may be mistaken for acute coronary syndromes. It can also precipitate life-threatening arrhythmias, including torsades de pointes and ventricular tachyarrhythmias…
Understanding ECG Artifacts
Key Points Artifacts = non-cardiac signals that distort or obscure true ECG. They come from the patient, leads/equipment, or the environment. Clues to artifact: lacks a physiologic pattern, varies beat-to-beat…
Ischemia & Infarction Interpretation
Key Points: The ECG is the fastest bedside tool for detecting acute coronary occlusion and dynamic ischemia, often before troponin changes and sometimes before classic symptoms. Acute coronary syndromes are…
Fascicular Ventricular Tachycardia (Idiopathic Left Fascicular VT)
Key Points Idiopathic reentrant VT arising within the left Purkinje system, most often the left posterior fascicle. Patients are usually young and lack structural heart disease. Signature ECG: RBBB-like morphology…
Opiate Toxicity
Key Point Opioid overdose causes life-threatening respiratory depression leading to hypoxia, altered mental status, bradycardia, hypotension, and potentially death. While most cardiovascular effects are secondary to hypoxia, methadone toxicity uniquely…
Methamphetamine Toxicity
Key Point Methamphetamine is a powerful sympathomimetic that causes a massive catecholamine surge, it can result in life-threatening cardiovascular and neurologic complications. Toxicity can present with MI, arrhythmias, stroke, hypertensive…
Beta-Blocker and Calcium Channel Blocker Toxicity
Key Point BBs and CCBs are widely prescribed but overdoses can cause life-threatening bradycardia, AV block, hypotension, and shock. Differentiating between them is important, but both require early recognition, aggressive…
Cocaine Toxicity
Key Point Cocaine is a powerful sympathomimetic with profound cardiovascular (CV) effects. Even recreational or first-time use can precipitate life-threatening complications, including myocardial infarction (MI), stroke, arrhythmias, and aortic dissection….
Isorhythmic AV Dissociation
Key Points Definition: A type of AV dissociation in which sinus and escape rates are nearly identical, so P waves and QRS complexes appear to “track” each other while remaining unrelated….
Third-Degree AV Block (Complete Heart Block)
Key Points: Definition: Third-degree AV block is complete failure of conduction from atria to ventricles, resulting in independent atrial and ventricular activity—known as AV dissociation. Hallmark Feature: No P waves…
High-Grade (Advanced) AV Block
Key Points Definition: A severe form of second-degree AV block with two or more consecutive non‑conducted P waves (for example 3:1, 4:1). Do not force a Mobitz label when multiple…
Irregularly Irregular Rhythm: Basics
Key Points: Definition: An irregularly irregular rhythm occurs when the R-R intervals or P-P intervals vary with no consistent pattern, making the rhythm unpredictable and abnormal. Clinical Significance: Identifying an…
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