Life Savers
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Ventricular Tachycardia (VT): Core Overview
Key Points VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
Ventricular Tachycardia (VT) Mimics
Key Points Initial Assumption: Any wide (QRS >120 ms), regular tachycardia should be considered ventricular tachycardia (VT) until clearly proven otherwise. VT Characteristics: VT generally has a ventricular rate of…
Pulseless Ventricular Tachycardia (pVT) Arrest
Key Points Defibrillation First, Minimal Pauses: pVT is rapidly fatal without immediate shocks and high‑quality CPR. Charge defibrillator during compressions and resume compressions immediately after each shock. pVT is a…
“Shark Fin” Massive STEMI Pattern
Key Points High-risk STEMI morphology caused by fusion of the terminal QRS, J point, ST segment, and T wave into a single “triangular” deflection. Often massive apparent STE with loss…
Electrical Storm
Key Points Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
Pulseless Electrical Activity (PEA) Arrest
Key Points Definition: Organized electrical activity on ECG without a palpable pulse. PEA is a non-shockable arrest rhythm requiring CPR, epinephrine, and identification of reversible causes. Confirmation: Verify in two…
Asystole (Cardiac Arrest)
Key Points Definition: Asystole is a non-shockable cardiac arrest rhythm characterized by absence of ventricular electrical activity. Treat with high-quality CPR, epinephrine every 3–5 minutes, and an urgent search for…
Critical ECG Emergencies (The Life Savers)
Key Points Definition: Critical ECGs are time-sensitive, life-threatening cardiac or systemic conditions that demand immediate ECG recognition to prevent death or irreversible organ injury. These are the “can’t-miss” rhythm strips…
Ventricular Fibrillation (VF) Arrest
Key Points Defibrillation First, Minimal Pauses: VF is rapidly fatal without immediate shocks and high‑quality CPR. Charge during compressions and resume compressions immediately after each shock. Chaotic Electrical Activity: VF…
Ventricular Flutter (V-Flutter)
Key Points Definition: A malignant ventricular tachyarrhythmia with a regular, sine-wave–like waveform at ~250–350 bpm, no isoelectric baseline, and no discernible P/QRS/T distinction. Clinical importance: Rapidly degenerates into ventricular fibrillation…
Post-Cardiac Arrest ECGs
Key Points Early post-ROSC ECGs often mislead. Within the first 8–10 minutes, transient global ischemia and catecholamines can exaggerate ST changes. Plan a repeat at 10–15 minutes before making cath…
Unstable Bradyarrhythmias
Key Points: Unstable bradyarrhythmias cause poor perfusion which can rapidly progress to shock, irreversible organ injury, or cardiac arrest. Priority: Do not treat the heart rate alone — treat clinical…
Unstable Tachyarrhythmias
Key Points: Intervene Immediately: Unstable tachyarrhythmias pose significant risk for rapid clinical deterioration that may lead to irreversible end-organ damage or cardiac arrest. Clinical Indicators of Instability: Altered Mental Status:…
Severe Hypothermia
Key Points Severe hypothermia causes rate- and temperature-dependent ECG changes that signal high arrhythmia risk. Recognition guides safe rewarming and prevents iatrogenic VF. Osborn (J) waves may appear and typically…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
Non-Thrombotic Causes of Acute Coronary Syndrome (ACS)
Key Points ACS ≠ Always Thrombosis: While most ACS is due to plaque rupture with thrombus formation, several important non-thrombotic causes can produce identical ECG changes, troponin elevation, and symptoms….
Cannabis (Marijuana) Toxicity
Key Point Cannabis use is rising across recreational and medical contexts. Causation is not proven, but multiple contemporary studies associate cannabis with acute cardiovascular events, including MI, stroke, arrhythmias, and…
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Key Points Definition and mechanics: Genetic hypertrophic cardiomyopathy with asymmetric LV hypertrophy, typically septal, causing dynamic LVOT obstruction from systolic anterior motion (SAM) of the mitral valve. Gradient worsens when…
Yamaguchi Pattern: Apical Hypertrophic Cardiomyopathy (ApHCM)
Key Points Definition and mechanics: Hypertrophic cardiomyopathy variant with maximal hypertrophy at the LV apex (apical HCM, ApHCM). LVOT is often not obstructed at rest; some patients have mid-ventricular obstruction…
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