Basics & Fundamentals

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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…

WPW with Antidromic SVT

Key Points WPW Syndrome: Wolff-Parkinson-White (WPW) syndrome is a condition characterized by ventricular pre-excitation due to a congenital accessory pathway in patients with symptomatic arrhythmias. ECG Recognition: The classic WPW…

WPW with Orthodromic SVT

Key Points WPW Syndrome: Wolff-Parkinson-White (WPW) syndrome is a condition where ventricular pre-excitation occurs due to a congenital accessory pathway in patients with symptomatic arrhythmias. ECG Recognition: The WPW ECG…

Premature Junctional Complexes (PJCs)

Key Points Origin: PJCs originate from ectopic foci near the AV junction, leading to premature impulses. ECG Characteristics: P Waves: May be absent or retrograde (inverted), appearing before, during, or…

Blocked Premature Atrial Complexes (PACs)

Key Points Definition: Blocked premature atrial complexes (PACs) are early ectopic atrial impulses not conducted to the ventricles, resulting in a visible P wave without a subsequent QRS complex. They…

Premature Ventricular Complexes (PVCs)

Key Points Origin and Characteristics: PVCs originate from ectopic ventricular foci, resulting in wide QRS complexes (>120 ms) with abnormal morphology, including discordant ST segments and T wave abnormalities. Types…

Premature Atrial Complexes (PACs)

Key Points Origin and Characteristics: PACs originate from ectopic atrial foci, resulting in abnormal P waves with different morphology and axis compared to sinus P waves. Hidden P Waves: Ectopic…

Premature Complexes (PACs, PJCs, & PVCs)

Key Points Spontaneous Depolarization: Different pacemaker cells in the heart can spontaneously depolarize at varying rates; the SA node is usually the fastest. Ectopic Impulses: Early depolarizations from ectopic foci…

Attending Level ECG Curriculum

Competencies: At the attending level, expert emergency and acute care physicians should proficiently interpret STAT ECGs to diagnose a wide range of emergent conditions—particularly those that are rapidly fatal. Mastery…

PGY-3 (Advanced) Resident ECG Curriculum

The Goals: Master rare and complex ECG findings and correlate them with clinical urgency. Integrate ECG data into immediate treatment decisions (e.g., combining with POCUS, vital signs, and physical exam)….

PGY-2 (Intermediate) Resident Curriculum

The Goals: Enhance speed and accuracy in ECG interpretation through repetition and practice. Recognize subtler findings and expand your differential diagnoses. Integrate nuanced ECG changes into clinical decision-making. Mentor junior…

PGY-1 (Foundational Resident) Curriculum

The Goals:  Establish a systematic approach, identify common arrhythmias, distinguish normal variants from dangerous abnormalities, and maintain a strong emphasis on clinical correlation. Core Topics Systematic Interpretation Step-by-Step Method: Rate…

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