Basics & Fundamentals
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Post-Cardiac Arrest ECGs Hub
Key Points: The first post-ROSC ECG is essential but imperfect. Obtain it immediately, but interpret it in context. Global ischemia, defibrillation, acidosis, hypothermia, vasopressors, artifact, and severe metabolic derangements can…
Post-Arrest STEMI: Cath Lab Decisions
Key Points: Persistent ST elevation after ROSC remains a guideline-supported indication for emergency coronary angiography. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends emergency angiography for patients after cardiac arrest with suspected…
Post-Arrest No STEMI: When Cath Can Wait
Key Points: Stable post-arrest patients without ST elevation should not go to reflex immediate cath solely because cardiac arrest occurred. Randomized trials in OHCA patients without ST elevation have not…
Normal Cardiac Conduction
Key Points: Normal cardiac conduction begins in the SA node, travels through the atria to the AV node, then enters the His-Purkinje system to activate both ventricles rapidly and synchronously….
Right Bundle Branch Block (RBBB)
Key Points: RBBB delays right ventricular activation. The left ventricle depolarizes normally through the left bundle, while the right ventricle is activated late by slow myocardial spread. ECG hallmark: QRS…
Left Bundle Branch Block (LBBB)
Key Points: LBBB delays left ventricular activation. The RV activates first through the intact right bundle, then the impulse spreads slowly from right to left across the septum and LV…
Junctional Tachycardia
Key Points: Junctional tachycardia is an uncommon supraventricular tachycardia arising from the AV junction, usually due to enhanced automaticity rather than reentry. It is usually a regular narrow-complex tachycardia, although…
Junctional Rhythms
Key Points: Junctional rhythms arise from the AV junction, usually the AV node or proximal His bundle, when the sinus node slows, fails, or impulses do not reach the ventricles…
Pediatric ECG: Basics
Key Points: Pediatric ECGs are not scaled-down adult ECGs. Right axis deviation, large R waves in V1, and T wave inversions in V1 to V3 are expected in healthy children….
Heart Rhythm: Basics
Key Points: Don’t trust the ECG machines automated interpretation. Confirm the rhythm yourself. Start with the ventricles (R–R pattern), then the atria (P waves), then the AV relationship (PR behavior/P:QRS)….
Heart Rate: Basics
Key Points: Never accept the machine’s rate blindly. Confirm it yourself as ECG computer interpretations are frequently inaccurate. Verify paper speed and gain first (default 25 mm/s, 10 mm/mV). Name…
Normal STAT ECGs
Key Points: Clinical Context: A single normal 12-lead ECG in the emergent setting does not exclude all life-threatening conditions such as early occlusion MI/ACS, PE, tamponade, or aortic catastrophe. Do…
Computer Interpreted “Normal” ECGs
Key Points: Do not trust a computer read of “normal” without your own review. Computer interpretation is especially unreliable for subtle or early ischemia, including hyperacute T waves, minimal ST…
Abnormal STAT ECGs
Key Points: Clinical Context: Abnormal ECGs must be interpreted within the patient’s presentation. Not all abnormalities are life-threatening, and high-risk conditions can still appear subtle or even “normal.” Serial Monitoring:…
Supraventricular Tachycardias (SVTs)
Key Points: SVT in bedside emergency medicine usually refers to a rapid regular tachycardia arising above the ventricles, most commonly AVNRT, AVRT, or atrial tachycardia. Most SVTs are regular narrow-complex…
Pacemaker Syndrome
Key Points: Pacemaker syndrome is a hemodynamic problem caused by loss of proper atrioventricular (AV) synchrony. Most commonly occurs with ventricular pacing that produces retrograde atrial activation, but can also…
Right Atrial Enlargement (RAE)
Key Points: RAE reflects increased right atrial size or pressure load and is usually a marker of underlying pulmonary or right-sided cardiac disease. The classic ECG clue is a tall,…
Left Atrial Enlargement (LAE)
Key Points: LAE reflects delayed and prolonged left atrial depolarization, usually from chronically elevated left atrial pressure or volume. Classic ECG clues are a broad, often notched P wave 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…
ECG Basics & Fundamentals Hub
Key Points: This hub organizes ECG basics and fundamentals into three complementary “start here” pathways: ECG definitions and measurement, how ECGs work and are generated, and the acute care STAT…
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