Basics & Fundamentals
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EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…
Right Axis Deviation DDx
Top 3 emergent causes of new rightward axis to consider: When encountering a new rightward axis on an ECG, immediately consider the following life-threatening conditions: Acute Right Heart Strain /…
Modified Sgarbossa Criteria
Key Points Diagnosis in LBBB and RV Pacing: Left bundle branch block (LBBB) and RV-paced rhythms can mask acute myocardial infarction (MI). However, specific ECG criteria, including the Smith-Modified Sgarbossa…
Hypercalcemia
Key Points Shortened QTc interval is the hallmark ECG finding of hypercalcemia, primarily due to a shortened ST segment duration. Hypercalcemia can mimic acute STEMI on ECG (pseudoinfarction pattern due…
ECG Evidence of Reperfusion After Occlusion
Key Points Dynamic Nature: Coronary artery occlusions can spontaneously reperfuse or re-occlude, causing rapidly changing ECG patterns. Real-Time ECG Utility: Recognizing reperfusion ECG patterns allows early identification of successful artery…
Congenital Long QT Syndrome
Key Points Congenital Long QT Syndrome (LQTS) is a group of genetic disorders characterized by a prolonged QT interval on ECG, leading to an increased risk of ventricular arrhythmias and…
Subtle ST Segment Elevation
(OMI Pattern)
Key Points ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…
de Winter T Waves
(OMI Pattern)
Key Points STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). This pattern…
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…
Proper ECG Lead Placement
Key Points ECGs are a simple yet powerful tool in acute care medicine. Accurate 12-lead ECGs require correct electrode placement to avoid misdiagnoses such as myocardial infarction (MI), bundle branch…
Appropriate Discordance
Key Points Definition: Appropriate discordance refers to a normal pattern of repolarization in which the ST segment and T wave are directed opposite to the main vector of the QRS…
Irregularly Irregular Rhythms
Key Points Definition: An irregularly irregular rhythm occurs when the R-R intervals or P-P intervals vary with no consistent pattern, making the rhythm unpredictable and abnormal. Clinical Significance: Identifying an…
Regularly Irregular Rhythms
Key Points Definition: A regularly irregular rhythm occurs when the distance between R-R intervals or P-P intervals varies in a consistent, repeating pattern throughout the ECG tracing. Significance: Determining the…
Ectopic Atrial Rhythm
Key Points Definition: Ectopic atrial rhythms occur when atrial depolarization originates from a site other than the sinoatrial (SA) node, producing P waves with abnormal morphology and axis on ECG….
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…
Brugada Syndrome (BrS)
Key Points Life-Threatening Sodium Channelopathy: Predisposes to ventricular arrhythmias (VF/VT) and sudden cardiac death (SCD), often in otherwise “healthy” hearts. When to Suspect BrS: Patients with syncope, unexplained “seizures,” ventricular…
Pulmonary Embolism (PE)
Key Points ECG Findings in PE: No single ECG pattern is diagnostic of acute PE, and ECG findings are typically nonspecific. However, certain ECG patterns, especially those indicating right heart…
Sinoatrial Nodal Reentry Tachycardia (SANRT)
Key Points Definition: Sinoatrial Nodal Reentrant Tachycardia (SANRT) is a rare type of paroxysmal supraventricular tachycardia (SVT) characterized by a reentry circuit within the sinoatrial (SA) node, similar in mechanism…
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…
Left Bundle Branch Block
Key Points Definition: LBBB occurs when electrical conduction through the left bundle branch is delayed or blocked, resulting in asynchronous and delayed activation of the left ventricle (LV) and a…
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