QRS
Results:
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…
Ventricular Paced Rhythms
Key Points: Ventricular pacing changes depolarization and repolarization, so ST-T segments often look abnormal. In most paced rhythms, some discordant ST deviation is expected and should not be mistaken for…
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…
Left Ventricular Hypertrophy (LVH)
Key Points: LVH reflects increased left ventricular muscle mass, usually from chronic pressure overload. Common causes include longstanding hypertension and aortic stenosis. ECG diagnosis is imperfect. Voltage criteria are specific…
Appropriate Discordance
Key Points: Appropriate discordance refers to the expected secondary ST segment and T wave pattern seen with abnormal ventricular depolarization, especially LBBB and ventricular-paced rhythm. The ST segment and T…
QRS Morphology and ST-T Interpretation: Basics
Key Points: Read the QRS before you read the ST segment or T wave. Ventricular depolarization shapes repolarization. Narrow QRS usually reflects normal His-Purkinje conduction. Wide QRS suggests abnormal ventricular…
ECG Foundations: Vectors, Leads, & Activation
Key Points: An ECG records voltage differences over time. The ECG tracing is a plot where the horizontal axis is time and the vertical axis is voltage. Leads are viewpoints….
Bidirectional Ventricular Tachycardia (BiVT)
Key Points: BiVT is a regular wide-complex tachycardia with strict beat-to-beat alternation of QRS axis and/or bundle-branch pattern (often an approximately 180° frontal-plane axis flip). In adults, assume digoxin toxicity…
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…
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…
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…
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…
Premature Complexes (PACs, PJCs, & PVCs) Overview
Key Points: Premature complexes are early depolarizations arising from the atrium, AV junction, or ventricle which interrupt the expected sinus rhythm. Rapid classification by origin: look for a P wave…
Premature Ventricular Complexes (PVCs)
Key Points PVCs are early ventricular depolarizations that produce a wide QRS with secondary ST-T changes and are usually followed by a full compensatory pause. No preceding P wave. A…
Accelerated Idioventricular Rhythm (AIVR)
Key Points: Definition: AIVR is a transient, usually benign ventricular rhythm often seen after reperfusion of an acute myocardial infarction (AMI), whether spontaneous or post-intervention (PCI or thrombolysis). Rate Differentiation:…
Right Ventricular Hypertrophy (RVH)
Key Points Definition: Chronic pressure/volume overload → thickened RV (pulm HTN, congenital lesions, pulmonary disease). ECG signature: Rightward axis, dominant R in V1, deep S in V5–V6, with possible right-sided…
QRS Complex: Basics
Key Points: Definition and measurement: The QRS complex is ventricular depolarization, measured from the earliest ventricular deflection (Q or R) to the latest S return to baseline in any lead….
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Key Points: Rare, inherited ventricular arrhythmia triggered by adrenergic stress during exertion or emotion. Classically presents in children or adolescents with syncope or cardiac arrest despite a normal resting ECG…
Artifact vs Ventricular Rhythms: DDx
Key Points Artifact is a common source of misdiagnosis for serious arrhythmias such as polymorphic ventricular tachycardia (PVT), torsades de pointes, or ventricular fibrillation (VF). Always correlate the ECG findings…
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