Core
Results:
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….
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…
Regularly Irregular Rhythm: Basics
Key Points: Definition: A regularly irregular rhythm occurs when the distance between R-R intervals or P-P intervals varies in a consistent, repeating pattern throughout the ECG tracing. Significance: Determining the…
Regular Rhythm: Basics
Key Points Rhythm Regularity: Regular rhythm is characterized by equal distances between consecutive P waves (P-P intervals) and QRS complexes (R-R intervals). Verify rhythms with calipers—don’t trust the machine interpretation…
Heart Rhythm: Basics
Key Points Don’t trust the ECG machines automated interpretation. Confirm the rhythm yourself. Start with the ventricles (R–R pattern), then the atria (P waves), then the AV relationship (PR behavior/P:QRS)….
Normal STAT ECG
Key Points: Clinical Context: A single normal 12-lead ECG in the emergent setting does not exclude life-threatening conditions such as occlusion MI, PE, tamponade, tension pneumothorax, or aortic dissection. Serial…
Heart Rate & Rhythm Interpretation
Key Points: Treat the patient, not just the number or rhythm. Start with a 10-second stability check. If the rhythm explains hypotension, shock, ischemic chest pain, altered mentation, or severe…
Sinus Arrhythmia
Key Points Definition: Phasic variation in sinus rate with respiration. P-P intervals shorten on inspiration and lengthen on expiration, producing a mild, patterned irregularity. Diagnostic threshold: Difference between the shortest…
Slow Ventricular Tachycardia (VT)
Key Points Definition: Slow ventricular tachycardia is defined as a wide complex tachycardia with a ventricular rate between 100–120 bpm. Distinction: Typical sustained VT usually exceeds 120 bpm. When encountering…
Sinus Arrest
Key Points Definition: Sinus pause/arrest is failure of the sinus node to generate an impulse, producing a transient absence of P waves. On ECG the pause does not equal an…
R-on-T Phenomenon
Key Points Definition: The R on T phenomenon occurs when an ectopic impulse (often a PVC or cardioversion shock) falls on the T wave of the preceding beat. Mechanism: Interrupting…
Multifocal Atrial Tachycardia (MAT)
Key Points Definition: Multifocal Atrial Tachycardia (MAT) is a rare type of irregularly irregular supraventricular tachycardia (SVT) characterized by the presence of at least three or more different P wave…
Abnormal STAT ECG
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:…
Right Ventricular STEMI: Criteria & Pitfalls
Key Points RV involvement accompanies up to ~40% of inferior STEMIs; isolated RV infarction is uncommon but high-impact when missed. Think RV MI when inferior STEMI is present and you…
Second-Degree AV Block Type II (Mobitz II)
Key Points: Definition: Sudden failure of AV conduction after at least two consecutive conducted beats with identical PR intervals, followed by a single non‑conducted P wave. Sinus rate: P–P interval…
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