Emergencies

ECG STAT July 15, 2025

Right Axis Deviation + ST Elevation: DDx

Key Points RAD combined with ST-segment elevation (STE) is an uncommon but high-risk finding. While STE often suggests acute coronary occlusion, this pattern rarely reflects classic STEMI. Several non-ischemic conditions…

ECG STAT July 7, 2025

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…

ECG STAT July 1, 2025

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…

ECG STAT June 6, 2025

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…

ECG STAT May 14, 2025

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:…

ECG STAT May 12, 2025

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…

ECG STAT April 25, 2025

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,…

ECG STAT April 25, 2025

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…

ECG STAT April 24, 2025

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…

ECG STAT April 20, 2025

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…

ECG STAT April 11, 2025

Pulmonary Embolism (PE)

Key Points ECG Findings in PE: No single ECG pattern is diagnostic of acute PE, and ECG findings are typically nonspecific. However, certain ECG patterns, especially those indicating right heart…

ECG STAT April 2, 2025

Polymorphic Ventricular Tachycardia (PMVT)

Key Points Definition: PMVT is a ventricular tachycardia characterized by beat-to-beat variations in QRS morphology, axis, and duration, reflecting multiple ventricular foci or reentrant circuits. Clinical Importance: PMVT is often…

ECG STAT March 28, 2025

Sodium Channel Blocker Toxicity

Key Points Recognizing the Danger: Sodium channel blocker toxicity can present with a variety of ECG changes that are critical to recognize, especially in patients with altered mental status or…

ECG STAT March 20, 2025

Nonsustained Ventricular Tachycardia

Key Points Definition: NSVT is defined as ≥3 consecutive ventricular beats, QRS duration >120 ms, rate typically 100-250 bpm (usually > 120 bpm), lasting less than 30 seconds without causing…

ECG STAT February 28, 2025

EMS ECGs in Acute Coronary Syndromes (ACS)

Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…

ECG STAT January 17, 2025

Subtle ST Segment Elevation: OMI Pattern

Key Points: ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…

ECG STAT January 11, 2025

Brugada Syndrome (BrS)

Key Points: Life-Threatening Sodium Channelopathy: Predisposes to ventricular arrhythmias (VF/VT) and sudden cardiac death (SCD), often in otherwise “healthy” hearts. When to Suspect BrS: Patients with syncope, unexplained “seizures,” ventricular…

ECG STAT January 6, 2025

Hypokalemic Periodic Paralysis

Key Points Definition: A rare ion channelopathy that causes sudden, reversible episodes of symmetric flaccid paralysis triggered by low serum potassium. It may be inherited or secondary to thyrotoxicosis or…

Weekly Workout October 23, 2023

Wide Complex Tachycardias: does response to Valsalva maneuvers or adenosine rule out ventricular tachycardia?

A 54-year-old man with no significant PMHx presents to the ED with palpitations. He is hemodynamically stable with a normal blood pressure. The following ECG is obtained prior to the…

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