Basics & Fundamentals
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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…
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…
Abnormal STAT ECG
Key Points Clinical Context: Abnormal ECG findings in emergent settings must always be interpreted within the clinical context. Not all abnormalities represent life-threatening conditions, while several emergent conditions may present…
Early Reciprocal Changes
(OMI Pattern)
Key Points ACS Dynamics: ACS is complex and dynamic, with occluded arteries potentially reperfusing and reoccluding at any time. ECG Pattern Recognition: Mastering ECG pattern recognition in ACS is crucial…
Acute Coronary Occlusion MI:
STEMI Criteria & Beyond
Key Points A STAT ECG is the most critical first test in patients with suspected acute coronary syndrome (ACS). It allows for early identification of acute coronary occlusion myocardial infarction…
Hyperkalemia
Key Points ECG as a Frontline Diagnostic Tool: Hyperkalemia often reveals itself on the ECG before lab confirmation. Early recognition of characteristic changes can be life-saving, especially in critically ill…
Wide QRS Complex DDx
Key Points A QRS duration greater than 120 ms indicates abnormal ventricular depolarization. A wide QRS can signal conditions that range from benign to immediately life-threatening. Developing a focused differential…
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…
Modified Sgarbossa Criteria
Key Points Wide QRS Rhythms Can Mask OMI: Left bundle branch block (LBBB) and right ventricular (RV)-paced rhythms alter ventricular depolarization, producing expected secondary ST/T changes. However, acute occlusion MI…
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…
Appropriate Discordance
Key Points Definition: Appropriate discordance is a normal repolarization pattern in which the ST segment and T wave are directed opposite to the main QRS vector. It reflects expected changes…
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…
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