Basics & Fundamentals
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Cerebral T Waves
Key Points What it is: Dramatic ECG repolarization abnormality from acute brain injury. Classic pattern is deep, symmetric T-wave inversions with prolonged QTc, often most prominent in anterolateral leads. Why…
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:…
Atrioventricular Nodal Reentry Tachycardia (AVNRT)
Key Points AVNRT is a paroxysmal, regular, usually narrow-complex SVT caused by a reentry circuit within or adjacent to the AV node. Dual-pathway physiology is typical. Bedside hallmark is a…
Atrioventricular Reciprocating Tachycardia (AVRT)
Key Points AVRT is a macroreentrant SVT that uses both the AV node and an accessory pathway. Orthodromic AVRT conducts down the AV node and up the pathway and is…
Atrial Fibrillation with RVR
Key Points Most Common Sustained Arrhythmia: Atrial Fibrillation (AFib) is the most frequently encountered sustained arrhythmia in clinical practice, particularly among the elderly population. Misdiagnosis Risk: AFib is commonly misdiagnosed…
ECG Findings in Tension Pneumothorax
Key Points Tension pneumothorax is a clinical diagnosis—ECG changes are nonspecific but can provide supportive evidence in the right context. Electrical changes are primarily due to mechanical effects of air…
Acute Chest Pain: DDx
Key Points In patients presenting with acute chest pain, identifying life-threatening conditions is essential. Use a systematic ECG approach alongside clinical context to evaluate for high-risk diagnoses that require immediate…
ECG Findings in Aortic Dissection
Key Points Aortic dissection or aneurysm can produce ischemic‑appearing ECGs due to coronary malperfusion, most often right coronary involvement causing inferior changes. Pseudo‑infarction patterns, ST‑deviation, and conduction blocks can occur…
Epsilon Waves
Key Points Definition: Small, low-amplitude positive deflections at the terminal QRS or very early ST segment, caused by delayed right ventricular activation through diseased myocardium. Association: Highly specific for arrhythmogenic…
Fascicular Blocks
Key Points Definition: Delay/block within the left bundle’s fascicles—left anterior (LAF) or left posterior (LPF)—alters ventricular activation and the QRS axis. Types: LAFB (common) → left axis deviation; LPFB (rare)…
ST Segment: Basics
Key Points Definition: The ST segment runs from the J point (end of QRS) to the start of the T wave, the interval between ventricular depolarization and repolarization. Normal: Usually…
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…
Q Wave: Basics
Key Points Definition and Measurement: A Q wave is the first negative deflection of the QRS. Measure width in ms from the onset below baseline to its return to baseline;…
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….
QT Interval: Basics
Key Points Definition: QT = onset of QRS → end of T; reflects total ventricular depolarization + repolarization. Rate correction (QTc): Use corrected QT interval, because QT shortens with faster…
R Wave: Basics
Key Points Definition: The R wave is the first positive deflection of the QRS complex, reflecting early ventricular depolarization, predominantly of the left ventricle. Normal progression: Precordial R amplitude increases…
Hypermagnesemia
Key Points ECG red flags: Bradycardia, PR/QRS/QT prolongation, flattened P, peaked T, → AV block/asystole at higher levels. Neuromuscular: Hyporeflexia → weakness → respiratory depression → coma. Immediate countermeasure (severe/symptomatic):…
Left Anterior Fascicular Block (LAFB)
Key Points Mechanism: Block in the left anterior fascicle → ventricular activation proceeds down the left posterior fascicle, then spreads inferior-to-superior and right-to-left across the LV. ECG signature: Left axis…
Left Posterior Fascicular Block (LPFB)
Key Points Mechanism: Block in the left posterior fascicle → LV activates mainly via the left anterior fascicle, spreading superior-to-inferior toward the inferior/posterior LV. ECG signature: Right axis deviation (RAD)…
Left Ventricular Hypertrophy (LVH)
Key Points Pathophysiology: Chronic pressure overload thickens the LV wall. Expect prolonged depolarization vectors and delayed repolarization that produce characteristic ECG voltage and ST-T changes. ECG signature: High precordial voltages,…
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