Basics & Fundamentals
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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…
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:…
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…
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 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…
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;…
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…
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