Basics & Fundamentals
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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…
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….
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…
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…
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….
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