Killer Differentials
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Wide & Regular Tachydysrhythmia DDx
Key Points Definition: Wide complex tachycardia (WCT) is defined by QRS duration >120 ms. The differentials are distinguished using the rhythm, regular wide complex rhythms (RWCT) are discussed here. The…
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 Point 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…
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:…
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…
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….
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…
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…
Not Enough P Waves (P:QRS < 1) DDx
Key Points Not Enough P’s: When the ratio of P waves to QRS complexes is less than 1, this suggests the presence of ectopic beats, escape rhythms, or abnormal conduction….
No Clear P Waves DDx
Key Points Absence of Sinus Rhythm: The lack of clear P waves before the QRS complexes suggests that sinus rhythm is not present. Potential Causes: This pattern can result from…
Tall R wave in V1 DDx
Key Points R Wave Represents Depolarization: The R wave in V1 reflects the initial depolarization of the ventricles, specifically the right ventricle. Height Relative to S Wave: In V1, the…
Cerebral T Waves
Key Points Definition: Cerebral T waves, also referred to as “roller coaster T waves,” are significant ECG changes associated with brain abnormalities. They are characterized by markedly large T waves…
Wide & Irregular Tachycardia DDx
Key Points Definition: Wide (QRS >120 ms) and irregular tachycardias demand rapid differentiation due to potentially life-threatening conditions. Clinical Priority: Always consider atrial fibrillation with an accessory pathway (e.g., WPW)…
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