A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as…
A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer…
Key Points: Life Savers are the can’t-miss ECGs. These patterns may reflect immediately life-threatening ischemic, electrical, mechanical, obstructive, toxicologic, or metabolic emergencies. This hub is built for rapid action. Use…
Key Points: Use a consistent ECG routine. In acute care, a repeatable approach reduces misses and helps you recognize dangerous patterns faster. Prioritize life threats first. Instability, malignant rhythms, occlusion…
A 68-year-old man has syncope, then has a second syncopal episode while lying still on a stretcher during evaluation at an outpatient clinic. He is sent emergently to the ED….
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…
A 49-year-old man arrives with palpitations and chest discomfort. The monitor shows an irregular, wide-complex tachycardia with varying morphology and rates nearing 250 to 300 bpm. The team debates polymorphic…
Key Points: Read the QRS before you read the ST segment or T wave. Ventricular depolarization shapes repolarization. Narrow QRS usually reflects normal His-Purkinje conduction. Wide QRS suggests abnormal ventricular…
Key Points: Pre-excitation means an accessory pathway allows atrial impulses to reach the ventricle without traversing the AV node, producing early ventricular activation. A delta wave is the defining ECG…
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…
Key Points: Short QT Syndrome (SQTS) is a rare condition characterized by a shortened QT interval on the ECG, increasing the risk of atrial and ventricular arrhythmias, including sudden cardiac…
Key Points: Definition and measurement: The P wave is atrial depolarization. Measure duration from initial deflection to return to baseline and amplitude from baseline to peak. Normal values: Duration <120…
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The…
Key Points: Definition: QT is measured from QRS onset to T-wave end. It reflects total ventricular depolarization plus repolarization. Use QTc: QT varies with heart rate. Interpret QTc, not the…
Key Points: Every ECG tracing is built from waveforms (deflections), segments (baseline portions between waveforms), and intervals (time that include waveforms plus segments). Waveforms describe electrical events (depolarization or repolarization)….
Why ECG Interpretation Matters: The ECG is one of the fastest, highest-impact diagnostic tests in acute care. When interpretation is rapid and accurate, patients get timely reperfusion, pacing, defibrillation, antidotes,…
Key Points: Definition: A true LV aneurysm is a chronic, post transmural MI complication from scarred myocardium with akinetic or dyskinetic (paradoxical) wall motion. ECG hallmark: Persistent ST elevation in…
Key Points Reperfusion after fibrinolysis is a bedside diagnosis using a bundle of findings: symptoms, ECG trend, and hemodynamic/electrical stability. Best ECG marker of successful fibrinolysis: at least 50% ST-segment…
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…
Key Points: Mechanical artifact caused by an ECG electrode sitting on top of a strong arterial pulse. Seen frequently in dialysis patients with AV fistulas. Can mimic serious pathology including…