Emergencies
Results:
LV Aneurysm vs STEMI: DDx
Key Points Left Ventricular Aneurysm (LVA): Causes persistent ST elevation lasting more than 2 weeks post-MI, typically seen in the anterior leads but can also affect the inferior leads. Occurs…
Atrial Flutter 1:1 Conduction
Key Points Rare, dangerous presentation. When atrial flutter conducts 1:1 through the AV node (or an accessory pathway), the ventricular rate can approach the atrial rate ~240–320 bpm, producing rapid…
Computer Interpreted “Normal” ECGs
Key Points Do not fully trust computer interpretations of “normal” ECGs, they may miss significant abnormalities. Computer algorithms can miss early ischemic signs such as reciprocal changes in aVL and…
STEMI (-) Occlusion MI: OMI Patterns
Key Points Traditional STEMI Criteria Alone Miss Acute Coronary Occlusion MI: Widely used but insufficiently sensitive or specific, many genuine occlusions (OMIs) do not meet strict STEMI criteria. Current Guidelines…
LV Aneurysm
Key Points Definition: LVA is a chronic complication of prior transmural MI, caused by scar tissue formation and paradoxical wall motion. Persistent ST Elevation: ST elevation lasting > 2 weeks…
Occlusion MI: STEMI Criteria & Beyond
Key Points A STAT ECG is the most critical first test in suspected acute coronary syndrome (ACS). It allows for early recognition of acute coronary occlusion myocardial infarction (OMI), a…
Pseudonormalization of T Waves
Key Points Definition: Pseudonormalization is the apparent normalization of previously inverted T waves, often signaling reocclusion of a coronary artery that had recently reperfused. Mechanism: During reperfusion, ischemic T wave…
STEMI vs Severe Hyperkalemia: DDx
Key Points The ECG Chameleon: Severe hyperkalemia can produce ST segment elevations, wide QRS complexes, and conduction delays that closely resemble STEMI or ventricular tachycardia. Early misinterpretation can lead to…
STEMI vs Wide QRS (BBBs & Paced Rhythms): DDx
Key Points Wide QRS & Repolarization Abnormalities: Bundle branch blocks (BBBs) and ventricular-paced rhythms (RV, LV, BiV) cause abnormal ventricular depolarization, leading to secondary ST segment and T wave changes—even…
Occlusion MI in Ventricular Paced Rhythms: STEMI Equivalent Pattern
Key Points 1. Paced Rhythms and Acute MI Detection: Ventricular paced rhythms significantly alter ST segment and T wave morphology, complicating acute myocardial infarction (MI) recognition. Accurate ECG interpretation in…
Occlusion MI in Left Bundle Branch Block: STEMI Equivalent Pattern
Key Points LBBB Does Not Exclude Acute Coronary Occlusion: LBBB alters ventricular activation, leading to expected secondary ST/T abnormalities. However, acute occlusion myocardial infarction (OMI) can and must still be…
Modified Sgarbossa Criteria: STEMI Equivalent Pattern
Key Points Wide QRS Rhythms Can Mask OMI: Left bundle branch block (LBBB) and right ventricular (RV)-paced rhythms alter ventricular depolarization, producing expected secondary ST/T changes. However, acute occlusion MI…
Hyperkalemic Periodic Paralysis (Impressive Syndrome)
Key Points What It Is: A rare autosomal dominant sodium channelopathy that leads to episodic muscle weakness or paralysis in the setting of elevated serum potassium. Named after “Impressive,” the…
Trifascicular Block
Key Points Definition: Trifascicular block describes ECG evidence of impaired conduction across all three fascicles: right bundle branch (RBB), left anterior fascicle (LAF), and left posterior fascicle (LPF). Common Usage:…
Sinus Node Dysfunction (Sick Sinus / Brady-Tachy Syndrome)
Key Points Spectrum, not one rhythm: Look for sinus brady, pauses, arrest, alternating atrial tachyarrhythmias (AF, flutter, ATach). Symptoms matter: Syncope, presyncope, fatigue usually come from cerebral/systemic hypoperfusion, especially after…
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…
Slow Atrial Fibrillation
Key Points Definition: Atrial fibrillation with a slow ventricular response, usually < 60 bpm. ECG: Irregularly irregular rhythm, no discrete P waves, slow R-R intervals. Common causes: AV-nodal blockers (digoxin,…
Sinoatrial Exit Block
Key Points Definition: SA exit block occurs when the sinus node generates impulses that are blocked before they can activate the right atrium, leading to dropped P waves on the…
Aslanger Pattern: OMI Pattern
Key Points: STEMI Diagnosis and Contiguous Leads: While current guidelines typically require ST elevation (STE) in at least two contiguous leads for the diagnosis of STEMI, this practice is not…
Precordial Swirl: OMI Pattern
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…
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