Killer Differentials
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T Wave Inversion in V1-V3 DDx
Key Points Common Misconception: T-wave inversions (TWIs) in V1–V3 are often prematurely labeled as “anteroseptal ischemia,” but there’s a much broader differential. Essential Differentials: Pulmonary causes (e.g., PE), Arrhythmogenic RV…
Large T Wave DDx
Key Points Large T waves on an ECG can have several different etiologies, ranging from benign to life-threatening conditions. It’s essential to interpret them in the clinical context and with…
Bradycardia DDx
Key Points Common Offenders: Beta-blockers, calcium channel blockers, and digoxin often top the list of medication-induced bradycardia. High Vagal Tone or AV Block can arise from structural heart disease, ischemia,…
T Wave Inversion DDx
Key Points Ischemia Isn’t Everything: While T-wave inversions often raise concern for ischemia, many non-ischemic processes (e.g., pulmonary pathology, neurologic conditions, repolarization variants) can produce similar findings. Clinical Correlation: Always…
Prolonged QT Interval DDx
Key Points Definition & Clinical Relevance The QT interval spans from the start of the Q wave to the end of the T wave, encompassing total ventricular depolarization and repolarization….
Wide & Regular Tachydysrhythmia DDx
Key Points Wide Complex Tachycardia: Refers to a tachycardia with a QRS duration greater than 120 ms and a regular rhythm. The classic teaching is to consider ventricular tachycardia (VT)…
Non-Conducted P Waves (P:QRS>1) DDx
Key Points ECG Interpretation Caveats: Computerized ECG interpretations are frequently unreliable in irregular rhythms or with non-conducted P waves. Misdiagnoses like atrial fibrillation are common—always manually verify. Differential Diagnosis Considerations:…
Low Voltage QRS DDx
Key Points Definition: Low voltage QRS is characterized by a QRS amplitude of less than 5 mm in limb leads and less than 10 mm in precordial leads. Sensitive Definition…
Clumped or Grouped Beats DDx
Key Points Clinical Implication: Clumped or grouped beats can cause irregular rhythms, often leading to misdiagnosis as atrial fibrillation. Misdiagnosing atrial fibrillation may lead to inappropriate rate/rhythm control or unnecessary…
Narrow & Regular Tachycardia DDx
Key Points Narrow Complex Tachycardia: Refers to a tachycardia with a QRS duration of less than 120 ms and a regular rhythm. The primary rhythms to consider in this scenario…
Acute Chest Pain DDx
Key Point When evaluating a patient with acute chest pain, it is crucial to consider rapidly fatal conditions and use a systematic approach to ECG interpretation to assess the probability…
ST Elevation DDx
Key Points Definition: ST elevation on an ECG refers to the upward displacement of the ST segment above the baseline, often indicating acute myocardial injury. Significance: While ST elevation is…
Poor R Wave Progression DDx
Key Points Poor R Wave Progression (PRWP): This refers to a situation where the R waves in the precordial leads (V1 to V6) fail to increase in amplitude as expected….
Abnormal P Wave Axis DDx
Key Points Normal Sinus Rhythm: In a normal rhythm, the sinus node initiates atrial depolarization, resulting in a P wave with a normal axis: upright in lead II, inverted in…
ST Elevation in aVR DDx
Key Points Global Subendocardial Ischemia: ST-segment elevation in aVR with diffuse ST-segment depression in multiple other leads typically reflects global subendocardial ischemia of the left ventricle. Proximal Vessel Occlusion: This…
Syncope DDx
Key Points Syncope and the ECG: Syncope is a transient loss of consciousness and postural tone, characterized by rapid onset, brief duration, and spontaneous recovery without medical intervention. Cardiac syncope…
Short QT Interval DDx
Key Points Short QT Interval: A QT interval is considered short when the corrected QT (QTc) interval is less than 350 ms. A short QT interval on the ECG can…
Right Axis Deviation + STE DDx
Key Points RAD + ST-Segment Elevation: When you encounter right axis deviation (RAD) combined with ST-segment elevation (STE) on an ECG, it’s crucial to consider differential diagnoses beyond STEMI, as…
Left Axis Deviation DDx
Key Points Definition: Left Axis Deviation (LAD) occurs when the QRS axis on an ECG is shifted leftward, typically between -30° and -90°. Common Causes: LAD is often associated with…
Right Axis Deviation DDx
Top 3 emergent causes of new rightward axis to consider: When encountering a new rightward axis on an ECG, immediately consider the following life-threatening conditions: Acute Right Heart Strain /…
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