Emergencies
Results:
UMEM Cases, Part 1: When the ECG Lies and When It Evolves
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…
South African Flag Sign: OMI Pattern
Key Points: Pattern: The South African Flag sign is the combination of ST elevation in I, aVL, and V2 with reciprocal ST depression in III. It is a subtle but…
Three ECG Traps You Cannot Afford to Miss
A 60-year-old woman presents with palpitations and an irregular wide-complex tachycardia. The computer calls atrial fibrillation with a left bundle branch block, but a subtle clue in the precordial leads…
Occlusion MI in Ventricular Paced Rhythms: STEMI Equivalent Pattern
Key Points: Ventricular paced rhythms can mask acute coronary occlusion. Pacing alters depolarization and produces expected secondary ST-T abnormalities, so standard STEMI criteria are unreliable. Appropriate discordance is expected in…
The Life Savers: Critical ECGs Hub
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…
Occlusion MI in Left Bundle Branch Block (LBBB): STEMI Equivalent Pattern
Key Points: LBBB does not exclude acute coronary occlusion. LBBB produces abnormal depolarization and expected secondary ST-T changes, which can mask or mimic ischemia. Acute OMI can still be recognized…
The Syncope ECG With Too Much P
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….
Electrical Alternans
Key Points: Electrical alternans is a beat-to-beat alternation in QRS amplitude, axis, or both. It is classically associated with a large pericardial effusion and may support concern for tamponade, but…
Pericardial Effusion
Key Points: Pericardial effusion is the accumulation of fluid in the pericardial sac. ECG may provide clues, but it is not sensitive enough to exclude effusion. Important ECG clues include…
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…
Pericardial Tamponade
Key Points: Pericardial tamponade is a hemodynamic diagnosis, not just an ECG diagnosis. ECG may show sinus tachycardia, low-voltage QRS, and sometimes electrical alternans, but none are sensitive enough to…
Modified Sgarbossa Criteria: STEMI Equivalent Pattern
Key Points: LBBB and ventricular-paced rhythms can hide acute coronary occlusion because abnormal depolarization creates expected secondary ST-T changes. Occlusion MI can still be recognized when those ST changes are…
Preexcitation Pitfalls (Part 4): Potpourri Cases & Final Teaching Points
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…
Preexcitation Syndromes: Overview
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…
Wolff-Parkinson White (WPW) Syndrome
Key Points: Pattern vs syndrome: WPW pattern is ECG evidence of pre-excitation without symptoms. WPW syndrome is pattern plus symptomatic tachyarrhythmia (palpitations, syncope, “seizure”, aborted sudden cardiac arrest). PR interval…
Short QT Syndrome
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…
Atrial Flutter 1:1 Conduction
Key Points: Rare, high-risk rhythm. 1:1 flutter can drive ventricular rates into the 240–320 bpm range and can rapidly cause hypotension, ischemia, or collapse. It often mimics VT. Ask “how…
WPW Syndrome and Pseudo-MI Patterns
Key Points: WPW alters ventricular depolarization, producing secondary repolarization abnormalities that can mimic or mask myocardial infarction. ST-segment deviation in WPW is often non-ischemic, driven by abnormal activation via the…
Atrial Fibrillation with WPW (Pre-excited AF)
Key Points: Pre-excited AF is the most dangerous WPW rhythm. It can deteriorate quickly to VF because the accessory pathway may conduct atrial impulses to the ventricle at extreme rates….
WPW with Antidromic SVT (Antidromic AVRT)
Key Points: Antidromic AVRT is an AV re-entrant tachycardia that conducts antegrade down the accessory pathway and returns retrograde through the AV node (or another pathway), producing a regular wide-complex…
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