A 23-year-old woman presents with palpitations and lightheadedness after a spontaneous episode of regular wide complex tachycardia. Her post-conversion ECG shows anterior T wave inversions with a subtle abnormality hiding…
Key Points: Hypokalemia delays ventricular repolarization, producing progressive changes in the T-U complex before serious arrhythmias develop. ECG progression: T-wave flattening → mild ST depression → prominent U waves →…
Key Points: Severe hypokalemia can result in an arrhythmia emergency. The major threat is ventricular tachyarrhythmias, including torsades de pointes, polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Severe…
Key Points: Hypermagnesemia is uncommon and usually occurs when impaired renal magnesium clearance is combined with increased magnesium exposure, such as magnesium-containing laxatives, antacids, bowel preparations, or therapeutic magnesium administration….
Key Points: Hypomagnesemia is an important arrhythmogenic electrolyte abnormality. It can promote atrial and ventricular ectopy and increase susceptibility to ventricular arrhythmias, particularly when other repolarization abnormalities are present. ECG…
Key Points: ECG hallmark: QT prolongation caused predominantly by ST-segment prolongation, usually with relatively preserved T-wave morphology. Arrhythmia risk: Severe hypocalcemia can predispose to ventricular arrhythmias, including torsades de pointes…
Key Points: What It Is: Severe hyperkalemia can cause sudden, profound, symmetric muscle weakness or flaccid paralysis. Dr. Mattu has referred to this memorable presentation as “Impressive Syndrome,” a teaching…
Key Points: Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Severe hyperkalemia is one of the most dangerous ECG mimics in emergency medicine. It can resemble unstable bradyarrhythmias, VT, STEMI, and pacemaker…
Key Points: ECG hallmark: Shortened QT interval, primarily due to shortening of the ST segment. STEMI mimic: Severe hypercalcemia can produce apparent ST-segment elevation and a pseudoinfarction pattern, occasionally mimicking…
Key Points: Definition: Hypokalemic periodic paralysis (HPP) is a rare disorder characterized by episodic, reversible flaccid muscle weakness associated with a shift of potassium from the extracellular space into skeletal…
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…
Key Points Tall, broad-based T–U fusion that looks like a mountain peak, usually from severe hypokalemia; think high torsades risk until proven otherwise. Hallmark is prolonged repolarization: QT appears long…
Key Points Definition and origin: The U wave is a small deflection following the T wave, best seen in V2–V3. It likely reflects late ventricular repolarization or Purkinje repolarization. Normal…
A 54-year-old woman presents to the emergency department with generalized weakness and nausea. She is tachycardic but otherwise has normal vital signs. The following ECG was obtained:
A 25-year-old woman presents to the emergency department with lightheadedness and palpitations for 1 week. Her symptoms worsened today with a near-syncopal episode. She is thin/frail and dehydrated in appearance….
A 56-year-old woman presents to a busy ED dehydrated with acute gastroenteritis. She is placed in a hallway bed and treated with IV fluids and ondansetron. On reassessment the patient…
A middle-age man presents to the ED with acute hypoxemic respiratory failure from multilobar pneumonia. He is intubated using etomidate and succinylcholine and noted to have a change in rhythm…
A 70-year-old woman presents to the ED with upper abdominal pain and vague paresthesias. The following ECG is obtained:
HPI: 32-year-old female with PMHx of hyperthyroidism (on carbimazole) presents with jaundice and intermittent palpitations. She has mild RUQ abdominal pain, but is otherwise well. Vitals: HR~100, BP-130/70, RR-18, afebrile. Exam:…
50-year-old woman with a PMHx of DM and obesity presents with dizziness and sub-acute back pain. She also reports myalgias and anorexia. She denies any associated chest pain, and is…