ECG Interpretation
Results:
ECG Hallucinations: When S1Q3T3 Misleads
A 51-year-old truck driver presents to the ED after a brief syncopal episode at a rest stop. It is the middle of summer, his truck’s air conditioning is not working,…
The Rhythm Behind the Irregularity
A 69-year-old woman presenting with sepsis gets the following ECG for tachycardia while febrile and shivering. The baseline is poor, atrial activity is difficult to identify, and the computer interpretation…
A Closer Look at the J Point
A 72-year-old man undergoes a prehospital 12-lead ECG. The tracing appears to show ST segment elevation in leads III, aVF, and aVR, raising concern for an inferior STEMI or high-risk…
Three High Risk ECGs and the Right Next Move
A 34 year old man presents with acute chest pain radiating to the left arm associated with diaphoresis. He has hyperlipidemia and a family history of early coronary disease. The…
Post-Arrest STEMI: Cath Lab or Caution?
A 72-year-old man is brought to the ED after witnessed cardiac arrest. Bystander CPR was started quickly, EMS found a nonshockable rhythm, epinephrine was given, and ROSC was achieved. Forty…
J Point: Basics
Key Points: The J point is the junction between the end of the QRS complex and the beginning of the ST segment. It is a location, not a separate waveform….
Post-Cardiac Arrest ECGs Hub
Key Points: The first post-ROSC ECG is essential but imperfect. Obtain it immediately, but interpret it in context. Global ischemia, defibrillation, acidosis, hypothermia, vasopressors, artifact, and severe metabolic derangements can…
Post-Arrest STEMI: Cath Lab Decisions
Key Points: Persistent ST elevation after ROSC remains a guideline-supported indication for emergency coronary angiography. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends emergency angiography for patients after cardiac arrest with suspected…
Post-Arrest No STEMI: When Cath Can Wait
Key Points: Stable post-arrest patients without ST elevation should not go to reflex immediate cath solely because cardiac arrest occurred. Randomized trials in OHCA patients without ST elevation have not…
Pediatric ECG in Cardiac Arrest
Key Points: Pediatric arrest is usually respiratory, hypoxic, or shock-related, not primary coronary occlusion. The ECG still matters because it can reveal reversible metabolic, toxicologic, structural, inflammatory, or inherited electrical…
A Post-Arrest ECG With a Dangerous New Bundle Branch Block
A 72-year-old man is brought to the ED after a witnessed out-of-hospital cardiac arrest. Bystander CPR is started quickly, EMS finds a non-shockable rhythm, and ROSC is achieved after one…
ECG Learning Resources & Recommendations
Key Points: ECG STAT is designed for point-of-care review, but ECG mastery requires repeated exposure, active interpretation, feedback, assessment, and clinical correlation. Use the ECG Skills curriculum tracks as your…
Recommended Online ECG Resources
Key Points: Online ECG resources are best used for repeated case exposure, quick review, and pattern reinforcement. They should complement, not replace, a structured ECG curriculum. ECG STAT is designed…
Sinoatrial Exit Block
Key Points: Definition: Sinoatrial, or SA, exit block occurs when the sinus node generates an impulse that fails to conduct into the surrounding atrial tissue. The blocked impulse produces no…
Normal Cardiac Conduction
Key Points: Normal cardiac conduction begins in the SA node, travels through the atria to the AV node, then enters the His-Purkinje system to activate both ventricles rapidly and synchronously….
UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135….
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…
UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not
A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the…
Pediatric ECG Red Flags
Key Points: Any wide QRS (>90 ms) in an infant or small child is abnormal and should trigger evaluation for VT, sodium-channel blockade, or conduction disease. QTc >450 ms in…
Pediatric ECG: Basics
Key Points: Pediatric ECGs are not scaled-down adult ECGs. Right axis deviation, large R waves in V1, and T wave inversions in V1 to V3 are expected in healthy children….
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