Basics & Fundamentals
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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”…
Atrial Fibrillation (AFib)
Key Points Prevalence: The most common sustained cardiac arrhythmia, particularly prevalent among elderly individuals, associated with increased stroke, heart failure, and mortality risks. Mechanism: Caused by chaotic, multiple reentry circuits…
Accelerated Idioventricular Rhythm (AIVR)
Key Points Definition: AIVR is a benign, self-limited ventricular rhythm frequently observed following reperfusion in acute myocardial infarction (AMI). Rate Differentiation: Characterized by a regular wide-complex rhythm with a ventricular…
Hypocalcemia
Key Points Prolonged QTc as the Hallmark ECG Change: Hypocalcemia primarily lengthens the ST segment, leading to a prolonged QTc interval, increasing the risk of arrhythmias like Torsades de Pointes…
Ischemia & Infarction
Key Points Purpose of ECG in ACS: One of the primary uses of an ECG is to detect signs of cardiac ischemia and infarction. Understanding the pathophysiology of Acute Coronary…
Acute Pericarditis
Key Points Diagnostic Challenge: Acute pericarditis symptoms and ECG findings can closely resemble STEMI/ACS, leading to frequent diagnostic uncertainty in acute care. Critical Importance: Rapid and accurate differentiation from STEMI…
P Wave Basics
Key Points Definition: The P wave represents atrial depolarization (the electrical activation of the atria immediately preceding atrial contraction). It is the first deflection or waveform in the ECG cardiac…
ECG 101: The Basics
Key Points: ECGs in Acute Care Medicine Rapid, Non-Invasive Screening Tool: ECGs provide quick, cost-effective assessment of cardiac function and rhythm. When interpreted accurately, they can significantly alter patient management…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
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…
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;…
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