Emergencies
Results:
Himalayan T Waves
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…
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 in Cardiac Arrest
Key Points ECG rhythms in pediatric arrest differ from adults. Pulseless arrest in children is most often asphyxial, but ECG clues can reveal reversible metabolic, toxicologic, or structural causes. Wide…
Pseudo-Wellens Waves
Key Points: Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Wellens Waves
Key Points Wellens waves are anterior precordial T wave abnormalities (biphasic or deeply inverted) most often in V2–V3, occasionally extending to V1 and V4–V6. They signal a high likelihood of…
Wellens Syndrome
Key Points: Clinical diagnosis, not an ECG pattern alone. Wellens syndrome requires the characteristic ECG findings plus the appropriate clinical scenario. Morphology alone is insufficient and high-risk if misapplied. Critical…
Torsade de Pointes (TdP)
Key Points Definition: TdP is a specific subtype of polymorphic ventricular tachycardia associated with a prolonged QTc interval. It often presents with a “twisting” pattern on ECG but can be…
Ventricular Tachycardia (VT): Core Overview
Key Points VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
Ventricular Tachycardia (VT) Mimics
Key Points: Initial Assumption: Any wide (QRS >120 ms), regular tachycardia should be considered ventricular tachycardia (VT) until clearly proven otherwise. VT Characteristics: VT generally has a ventricular rate of…
Pulseless Ventricular Tachycardia (pVT) Arrest
Key Points Defibrillation First, Minimal Pauses: pVT is rapidly fatal without immediate shocks and high‑quality CPR. Charge defibrillator during compressions and resume compressions immediately after each shock. pVT is a…
Shark Fin “Massive STEMI” Pattern
Key Points: High-risk STEMI morphology caused by fusion of the terminal QRS, J point, ST segment, and T wave into a single “triangular” deflection. Often massive apparent STE with loss…
Electrical Storm
Key Points Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
Pulseless Electrical Activity (PEA) Arrest
Key Points Definition: Organized electrical activity on ECG without a palpable pulse. PEA is a non-shockable arrest rhythm requiring CPR, epinephrine, and identification of reversible causes. Confirmation: Verify in two…
Asystole (Cardiac Arrest)
Key Points Definition: Asystole is a non-shockable cardiac arrest rhythm characterized by absence of ventricular electrical activity. Treat with high-quality CPR, epinephrine every 3–5 minutes, and an urgent search for…
Ventricular Fibrillation (VF) Arrest
Key Points Defibrillation First, Minimal Pauses: VF is rapidly fatal without immediate shocks and high‑quality CPR. Charge during compressions and resume compressions immediately after each shock. Chaotic Electrical Activity: VF…
Ventricular Flutter (V-Flutter)
Key Points Definition: A malignant ventricular tachyarrhythmia with a regular, sine-wave–like waveform at ~250–350 bpm, no isoelectric baseline, and no discernible P/QRS/T distinction. Clinical importance: Rapidly degenerates into ventricular fibrillation…
Post-Cardiac Arrest ECGs
Key Points Early post-ROSC ECGs often mislead. Within the first 8–10 minutes, transient global ischemia and catecholamines can exaggerate ST changes. Plan a repeat at 10–15 minutes before making cath…
Unstable Bradyarrhythmias
Key Points: Unstable bradyarrhythmias cause poor perfusion which can rapidly progress to shock, irreversible organ injury, or cardiac arrest. Priority: Do not treat the heart rate alone — treat clinical…
Unstable Tachyarrhythmias
Key Points: Intervene Immediately: Unstable tachyarrhythmias pose significant risk for rapid clinical deterioration that may lead to irreversible end-organ damage or cardiac arrest. Clinical Indicators of Instability: Altered Mental Status:…
Severe Hypothermia
Key Points Severe hypothermia causes rate- and temperature-dependent ECG changes that signal high arrhythmia risk. Recognition guides safe rewarming and prevents iatrogenic VF. Osborn (J) waves may appear and typically…
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