DDx
Results:
Not Enough P Waves (P:QRS < 1): DDx
Key Points: Fewer visible P waves than QRS complexes means some ventricular beats are not preceded by an identifiable sinus P wave. This usually reflects: Premature junctional or ventricular beats…
No Clear P Waves: DDx
Key Points: “No clear P waves” is an ECG finding, not a diagnosis. P waves may be truly absent, replaced by abnormal atrial activity, buried within the QRS or T…
Too Many P Waves (P:QRS>1): DDx
Key Points: More P waves than QRS complexes means that some atrial impulses are not activating the ventricles. The cause may be a premature atrial impulse that arrives while the…
Wide QRS Complex: DDx
Key Points: A QRS duration greater than 120 ms reflects delayed or abnormal ventricular depolarization. A wide QRS may be chronic and benign in context, or it may be the…
ST Elevation in aVR: DDx
Key Points: ST elevation (STE) in aVR with diffuse ST depression most often reflects global subendocardial ischemia, not focal transmural infarction. High-risk coronary disease is one cause, not the only…
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…
Must-Know Differentials (DDx) Hub
Key Points: The Must-Know DDx hub is your rapid reference for ECG-centered differential diagnosis in acute care. Use it when you recognize an ECG abnormality but need a focused list…
T Wave Inversion in V1-V3: DDx
Key Points: Anterior T wave inversion in V1-V3 is not synonymous with “anteroseptal ischemia.” The differential includes ACS, right heart strain, conduction/structural disease, and normal variants. In acute care, the…
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…
ST Depression: DDx
Key Points: ST depression is a pattern, not a diagnosis. It can represent ischemia, reciprocal change, baseline repolarization abnormalities, or noncardiac physiology. First split: regional (territorial) ST depression vs diffuse…
Short QT Interval: DDx
Key Points: Short QT Interval: A QT interval is considered short when the corrected QT (QTc) interval is less than 350 ms. A short QT interval on the ECG can…
Prolonged QT Interval: DDx
Key Points: The QT interval reflects the time it takes for total ventricular depolarization and repolarization (Q wave onset to T wave end). QT prolongation increases the risk of torsades…
ST Elevation: DDx
Key Points: ST elevation describes an ECG finding, not a diagnosis. It reflects abnormal ventricular repolarization and can arise from ischemic, structural, metabolic, electrical, or extracardiac processes. Occlusion MI is…
Diffuse ST Elevation: DDx
Key Points: ST-segment elevation (STE) is an ECG finding, not a diagnosis. Multiple ischemic and non-ischemic processes can produce STE. Diffuse STE is often non-ischemic, in contrast to the regional…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is a common, benign ECG pattern that most often appears in young, healthy patients. It can closely resemble acute anterior STEMI, creating a high-risk diagnostic…
STEMI vs LV Aneurysm: DDx
Key Points: LV aneurysm pattern is a post MI scar pattern with persistent ST elevation in the prior infarct territory, usually with pathologic Q waves and a stable, non evolving…
STEMI Mimics: DDx
Key Points: ST elevation is a pattern, not a diagnosis. STEMI represents one cause of ST elevation and requires correlation with ECG morphology, distribution, evolution, and clinical context. Most ED…
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…
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…
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