Basics & Fundamentals
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Right Ventricular Hypertrophy (RVH)
Key Points Definition: RVH refers to the thickening of the right ventricular muscle, often due to chronic pressure overload conditions like pulmonary hypertension or congenital heart disease. ECG Features: Look…
Hypomagnesemia
Key Points Prolonged QT & PR Intervals significantly increase the risk of torsades de pointes and other arrhythmias. Atrial & Ventricular Ectopy is common; can progress to life-threatening ventricular tachycardia….
Acute Coronary Syndromes (ACS)
Key Points ECG Importance: The ECG is the most crucial initial test in evaluating patients with suspected ACS. Its primary role is to identify those with acute coronary occlusion (OMI)…
Earliest Evidence of Occlusion MI
Key Points Dynamic Nature of ACS: Acute coronary syndromes (ACS) are complex and dynamic, with coronary arteries potentially undergoing reperfusion and reocclusion at any time. The ECG can provide real-time…
Electrical Alternans
Key Points Electrical alternans is classically associated with pericardial tamponade but occurs in fewer than 30% of confirmed cases. Low voltage QRS and sinus tachycardia combined raise suspicion for a…
Hyperkalemia
Key Points ECG as a Diagnostic Tool: The ECG is a critical tool for identifying hyperkalemia early, often before lab results are available. Recognizing specific ECG changes can be life-saving….
Ventricular Tachycardia (VT) Mimics
Key Points Wide Complex Tachycardias (WCT): When encountering a wide complex (QRS > 120ms) tachycardia with regular rhythm, the initial assumption should be ventricular tachycardia (VT) until proven otherwise. VT…
WPW Syndrome and Pseudo-MI patterns
Key Points WPW Pattern Mimics: Wolff-Parkinson-White (WPW) syndrome can produce an ECG pattern that mimics conditions such as myocardial infarction, ventricular bigeminy, accelerated idioventricular rhythm, and electrical alternans. ST Segment…
Hyperkalemia Emergencies
Key Points Severe hyperkalemia can mimic unstable bradyarrhythmias that resist standard ACLS interventions. It can produce extremely wide QRS complexes and bizarre rhythms that appear identical to ventricular tachycardia (VT)….
Pulse-Tapping Artifact
Key Points Pulse tapping artifact is caused by arterial pulsations mechanically influencing an ECG electrode, often leading to ST-segment changes and bizarre T waves. It mimics critical conditions like myocardial…
Artifact vs. Ventricular Rhythms
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…
Pediatric ECG Essentials
Key Points Rightward Axis in Kids: Early in life, the right ventricle is dominant, producing a large R wave in V1–V2 and minimal S waves in V5–V6. Significance: Recognize this…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points Definition & Terminology Arrhythmogenic Cardiomyopathy (ACM) is an inherited disorder marked by progressive replacement of ventricular myocardium (primarily RV) with fibrofatty tissue. Formerly called Arrhythmogenic Right Ventricular Cardiomyopathy…
Persistent Juvenile T wave Pattern
Key Points Benign Variant: Persistent juvenile T waves (PJTW) is not pathological in the absence of suspicious symptoms or other abnormal findings. Typical Distribution: T-wave inversions (or biphasic T waves)…
Spiked Helmet Sign (SHS)
Key Points The Spiked Helmet Sign (SHS) is a rare but important ECG pattern characterized by pseudo ST-segment elevation that starts before the onset of the QRS complex. SHS is…
Atrial Parasystole
Key Points Definition: A rare arrhythmia in which a secondary atrial focus fires at its own inherent rate, largely “shielded” from sinus node impulses. Characteristic ECG Finding: Two distinct P-wave…
T Wave Inversion DDx
Key Points Ischemia Isn’t Everything: While T-wave inversions often raise concern for ischemia, many non-ischemic processes (e.g., pulmonary pathology, neurologic conditions, repolarization variants) can produce similar findings. Clinical Correlation: Always…
Lewis Lead
Key Points The Lewis Lead is a modified ECG lead configuration that enhances visualization of atrial activity, providing diagnostic clarity in challenging dysrhythmias. Especially helpful in distinguishing ventricular tachycardia (VT)…
Prolonged QT Interval DDx
Key Points Definition & Clinical Relevance The QT interval spans from the start of the Q wave to the end of the T wave, encompassing total ventricular depolarization and repolarization….
STEMI Mimics
Key Points Contextual Interpretation: The accuracy of ECG interpretation depends on the pretest probability for the condition being evaluated. ECGs should always be interpreted in the context of the clinical…
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