Emergencies
Results:
Earliest Evidence of Occlusion MI
Key Points ACS is dynamic. Coronary arteries can occlude, partially reperfuse, and re-occlude over minutes to hours, and the ECG can show these shifts before biomarkers do. The earliest actionable…
ECG Evidence of Reperfusion After Occlusion
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…
Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Hypomagnesemia
Key Points: Hypomagnesemia is an important arrhythmogenic electrolyte abnormality. It increases risk of atrial and ventricular ectopy, ventricular tachycardia, and torsades de pointes, especially when QT is prolonged. The most…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition & Terminology: Arrhythmogenic Cardiomyopathy (ACM), previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly…
de Winter T Waves: STEMI Equivalent Pattern
Key Points STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). Treat the…
New RBBB and LAFB (Bifascicular Block) in ACS
Key Points Think proximal LAD / septal ischemia until proven otherwise when a patient with ischemic symptoms develops new RBBB + LAFB, especially with hemodynamic instability. Do not “normalize” ST…
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…
High-Risk Pulmonary Embolism
Key Points: The ECG can provide early clues to high-risk PE and may identify patients at risk for rapid hemodynamic collapse. Right ventricular strain patterns are the core high-risk markers….
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
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…
ECG Tags
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