Basics & Fundamentals
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Atrial Flutter
Key Points Definition: Atrial flutter is a common type of supraventricular tachycardia caused by a re-entry circuit within the right atrium. Atrial Rate: Typically around ~300 bpm, ranging from 240-360…
Flutter Waves (F waves)
Key Points Atrial Flutter Overview: Atrial flutter is a common type of supraventricular tachycardia caused by a re-entry circuit within the right atrium. Atrial Rate: The atrial rate in atrial…
Electrical Alternans
Key Points Classically associated with pericardial tamponade but seen in fewer than 30% of confirmed cases. Combination of low-voltage QRS + sinus tachycardia strongly suggests pericardial effusion/tamponade. Always perform rapid…
Pericardial Effusion
Key Point Always consider pericardial effusion in any patient with new low-voltage QRS complexes combined with sinus tachycardia. Prompt bedside ultrasound (POCUS) prevents diagnostic delays and potentially catastrophic outcomes. Classic…
Acute Chest Pain DDx
Key Point In patients presenting with acute chest pain, rapidly identifying life-threatening conditions is essential. Use a systematic ECG approach alongside clinical context to evaluate for high-risk diagnoses that require…
QT Interval Basics
Key Points Definition: The QT interval is a measure of the time from the beginning of the QRS complex to the end of the T wave. It reflects the total…
Torsades de Pointes (TdP)
Key Points Definition: TdP is a specific subtype of polymorphic ventricular tachycardia associated with a prolonged QTc interval. It often presents with a “twisting” pattern on ECG but can be…
Polymorphic Ventricular Tachycardia (PMVT)
Key Points Definition: PMVT is a ventricular tachycardia characterized by beat-to-beat variations in QRS morphology, axis, and duration, reflecting multiple ventricular foci or reentrant circuits. Clinical Importance: PMVT is often…
Normal STAT ECG
Key Points Clinical Context: A normal 12-lead ECG in acute settings does not exclude life-threatening pathologies (e.g., occlusion myocardial infarction [OMI], pulmonary embolism [PE], cardiac tamponade, tension pneumothorax, aortic dissection)….
Ventricular Fibrillation (VF)
Key Points Rapidly Fatal Rhythm: VF is the most critical shockable cardiac arrest rhythm, requiring immediate defibrillation and high-quality CPR to prevent sudden cardiac death within minutes. Chaotic Electrical Activity:…
Third-Degree AV Block
(Complete Heart Block)
Key Points Definition: Third-degree AV block is complete failure of conduction from atria to ventricles, resulting in independent atrial and ventricular activity—known as AV dissociation. Hallmark Feature: No P waves…
Acute Coronary Syndromes (ACS)
Key Points ECG First: The ECG is the most important initial test for suspected ACS. STAT ECGs help identify acute coronary occlusion MI (OMI) that require emergent reperfusion. Time-Sensitive Dx:…
Sodium Channel Blocker Toxicity
Key Points Recognizing the Danger: Sodium channel blocker toxicity can present with a variety of ECG changes that are critical to recognize, especially in patients with altered mental status or…
The Lewis Lead (Unmasking Atrial Activity)
Key Points Purpose: The Lewis Lead (modified S5 lead) is a bedside ECG modification designed to enhance visualization of atrial activity, particularly valuable in differentiating challenging arrhythmias such as VT…
Monomorphic Ventricular Tachycardia
Key Points Most Common Form: Monomorphic VT is the most frequent type of sustained ventricular tachycardia. Rate: Typically regular, rapid heart rate (>120-130 bpm). Be cautious of mimics when rate…
Ventricular Tachycardia (VT)
Key Points Definition: VT is a wide complex tachycardia arising from the ventricles, defined as ≥3 consecutive ventricular beats, QRS duration >120 ms, with rapid heart rate typically 120-250 bpm….
Supraventricular Tachycardia (SVT)
Key Points Definition: SVT refers to any tachyarrhythmia that originates above the ventricles (atria, AV node, or bundle of His). Most present as regular narrow-complex tachycardias, although aberrant conduction can…
Nonsustained Ventricular Tachycardia
Key Points Definition: NSVT is defined as ≥3 consecutive ventricular beats, QRS duration >120 ms, rate typically 100-250 bpm (usually > 120 bpm), lasting less than 30 seconds without causing…
Atrial Tachycardia
Key Points: Definition: Atrial tachycardia is a supraventricular arrhythmia characterized by rapid atrial depolarizations from one or more ectopic foci outside the SA node. Atrial Rate: > 100 bpm, typically…
Atrial Flutter 2:1 Conduction
Key Points Mechanism: Atrial flutter results from a macro re-entry circuit typically located within the right atrium, causing rapid and regular atrial activation (~300 bpm commonly). ECG Appearance: Classic “saw-tooth”…
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