Basics & Fundamentals
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T Wave Basics (ventricular repolarization)
Key Points Definition: T waves represent ventricular repolarization, the process by which the heart’s ventricles reset electrically after a heartbeat. Normal Characteristics: A normal T wave is upright in most…
T Wave Alternans
Key Points Definition: T wave alternans (TWA) is a phenomenon where there is a beat-to-beat variation in the amplitude or morphology of the T wave on the ECG, without affecting…
Hypomagnesemia
Key Points Prolonged QT & PR Intervals significantly increase the risk of torsades de pointes and other arrhythmias. Atrial & Ventricular Ectopy is common; can progress to life-threatening ventricular tachycardia….
Earliest Evidence of Occlusion MI
Key Points Dynamic Nature of ACS: Acute coronary syndromes (ACS) are complex and dynamic, with coronary arteries potentially undergoing reperfusion and reocclusion at any time. The ECG can provide real-time…
Hyperkalemia
Key Points ECG as a Diagnostic Tool: The ECG is a critical tool for identifying hyperkalemia early, often before lab results are available. Recognizing specific ECG changes can be life-saving….
WPW Syndrome and Pseudo-MI patterns
Key Points WPW Pattern Mimics: Wolff-Parkinson-White (WPW) syndrome can produce an ECG pattern that mimics conditions such as myocardial infarction, ventricular bigeminy, accelerated idioventricular rhythm, and electrical alternans. ST Segment…
Hyperkalemia Emergencies
Key Points Severe hyperkalemia can mimic unstable bradyarrhythmias that resist standard ACLS interventions. It can produce extremely wide QRS complexes and bizarre rhythms that appear identical to ventricular tachycardia (VT)….
Pulse-Tapping Artifact
Key Points Pulse tapping artifact is caused by arterial pulsations mechanically influencing an ECG electrode, often leading to ST-segment changes and bizarre T waves. It mimics critical conditions like myocardial…
Artifact vs. Ventricular Rhythms
Key Points Artifact is a common source of misdiagnosis for serious arrhythmias such as polymorphic ventricular tachycardia (PVT), torsades de pointes, or ventricular fibrillation (VF). Always correlate the ECG findings…
Pediatric ECG Essentials
Key Points Rightward Axis in Kids: Early in life, the right ventricle is dominant, producing a large R wave in V1–V2 and minimal S waves in V5–V6. Significance: Recognize this…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points Definition & Terminology: Arrhythmogenic Cardiomyopathy (ACM), previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly…
Spiked Helmet Sign (SHS)
Key Points The Spiked Helmet Sign (SHS) is a rare but important ECG pattern characterized by pseudo ST-segment elevation that starts before the onset of the QRS complex. SHS is…
Atrial Parasystole
Key Points Definition: A rare arrhythmia in which a secondary atrial focus fires at its own inherent rate, largely “shielded” from sinus node impulses. Characteristic ECG Finding: Two distinct P-wave…
STEMI Mimics
Key Points Contextual Interpretation: The accuracy of ECG interpretation depends on the pretest probability for the condition being evaluated. ECGs should always be interpreted in the context of the clinical…
Hypokalemia
Key Points Hypokalemia primarily affects ventricular repolarization, producing characteristic changes on the ECG. Progressive ECG changes include T-wave flattening, prominent U-waves, and a prolonged QT interval due to T-U fusion….
Early Repolarization vs. STEMI
Key Points Differentiation Challenge: Early repolarization (ER) is a benign ECG pattern often seen in healthy young individuals, characterized by ST segment elevation that can mimic STEMI and acute pericarditis….
LV Aneurysm vs. STEMI
Key Points Left Ventricular Aneurysm (LVA): Causes persistent ST elevation lasting more than 2 weeks post-MI, typically seen in the anterior leads but can also affect the inferior leads. Occurs…
Upright T waves in V1
Key Point Normal T Wave in V1: The normal ECG typically shows a flat or inverted T-wave in lead V1. Upright T-Wave Abnormality: An upright T-wave in V1 (TV1) should…
Understanding ECG Artifacts
Key Points ECG artifacts are distortions in the ECG signal that mimic or obscure true cardiac activity. Artifacts can arise from patient-related factors, technical issues, or environmental interference. Common types…
Q Wave Basics
Key Points Definition: Q waves are the first negative deflection of the QRS complex, representing early ventricular depolarization. They are measured in duration (ms) from the begining to the end…
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