Basics & Fundamentals
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Escape-Capture Bigeminy
Key Points Escape-capture bigeminy is a unique rhythm characterized by alternating escape beats and normally conducted sinus beats, resulting in a bigeminal (paired) rhythm pattern. It typically occurs in patients…
Ventricular Escape Rhythms
Key Points Wide QRS Complex Rhythm: Ventricular escape rhythms (aka idioventricular rhythms) are characterized by a wide QRS duration (>120 ms), absent or dissociated P-waves, and a regular, slow ventricular…
Junctional Escape Rhythms
Key Points Narrow QRS Complexes typically indicate junctional escape rhythms, originating near the AV node or proximal His-Purkinje system. These generally have a more favorable prognosis. Wide QRS Complexes suggest…
The Bix Rule
(Unmasking Atrial Flutter)
Key Points The Bix Rule refers to a simple but powerful ECG clue: if you observe a consistent P wave located exactly halfway between two QRS complexes, suspect concealed atrial…
Sinus Tachycardia
Key Points Definition: Sinus tachycardia is a regular rhythm originating from the sinoatrial (SA) node, defined by a heart rate >100 bpm in adults or above age-adjusted norms in children….
Ashman Phenomenon
Key Points Definition: Ashman phenomenon is an aberrant intraventricular conduction pattern triggered by cycle-length variation. It is most often seen in atrial fibrillation but can appear in any supraventricular rhythm….
Pseudo-Wellens Waves
Key Points Wellens Syndrome: A critical condition resulting from severe stenosis of the left anterior descending (LAD) coronary artery, characterized by specific ECG patterns known as Wellens waves. This is…
Sinus Node Dysfunction
(Sick Sinus Syndrome, “Brady-Tachy” Syndrome)
Key Points Spectrum of Arrhythmias: Sinus node dysfunction produces alternating periods of inappropriate bradycardia (sinus bradycardia, pauses, arrest) and paroxysmal atrial tachyarrhythmias (AF, atrial flutter, atrial tachycardia). Symptom Driver: Transient…
Wellens Waves
Key Points Significance: Wellens waves are T wave abnormalities (either biphasic or deeply inverted) in the mid-precordial leads (V2-V3, +/-V4-6) that are highly specific for critical obstruction of the left…
Right Atrial Enlargement (RAE)
Key Points Definition: Right atrial enlargement (RAE) is an increase in the size of the right atrium, typically resulting from chronic pressure or volume overload, commonly related to cardiac or…
Left Atrial Enlargement (LAE)
Key Points Definition: Left atrial enlargement (LAE) occurs when the left atrium dilates due to chronic pressure or volume overload. It commonly reflects underlying structural heart disease, particularly involving the…
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…
Occlusion MI
STEMI Criteria & Beyond
Key Points A STAT ECG is the most important initial test in patients with suspected acute coronary syndrome (ACS), enabling rapid identification of acute coronary occlusion myocardial infarction (OMI), a…
Atrioventricular Blocks (AVB) Summary
Key Points Conduction Abnormalities Overview: Heart blocks are classified based on the location of conduction delay or block within the cardiac conduction system: Sinoatrial (SA) Block: Occurs at the SA…
Dextrocardia
Key Points Dextrocardia: A congenital condition where the heart is located on the right side of the chest. Situs Inversus Totalis: A complete reversal of thoracic and abdominal organs, including…
Persistent Juvenile T wave Pattern
Key Points Benign Variant: Persistent juvenile T waves (PJTW) represent a benign ECG finding and require no further evaluation in the absence of clinical symptoms or concerning findings. Typical Distribution:…
Lead Misplacement
Key Points Proper lead placement is critical to avoid misdiagnoses that can lead to unnecessary interventions and patient harm. Misplaced precordial leads (V1-V6) can mimic ischemia and cause false MI…
Left Posterior Fascicular Block (LPFB)
Key Points Anatomy of the Left Bundle Branch: The left bundle branch divides into two main fascicles: the left anterior fascicle (LAF) and the left posterior fascicle (LPF), both of…
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