Basics & Fundamentals

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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…

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…

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…

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….

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 Mimics Several Life-Threatening Conditions: Hyperkalemia can produce a wide range of ECG abnormalities that resemble unstable brady and tachy arrhythmias, STEMI, and can also cause pacemaker…

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…

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