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Pulseless Electrical Activity (Cardiac Arrest)
Key Points PEA is organized electrical activity on ECG with no palpable pulse. It is a non shockable arrest. Treat with CPR, epinephrine, and rapid search for a reversible cause. Confirm…
Asystole (Cardiac Arrest)
Key Points Asystole is a nonshockable cardiac arrest rhythm. Treat with high-quality CPR and epinephrine while searching for reversible causes. Always confirm asystole in two leads and rule out fine…
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…
Critical ECG Emergencies (The Life Savers)
Key Points Definition: STAT ECGs are emergent tracings obtained to rapidly diagnose and guide management of life-threatening conditions. These are ECGs you cannot afford to miss in any acute care…
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…
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…
Syncope Emergencies
Key Points ECG and monitor early: First-time seizure, near-syncope, unexplained LOC, or syncope all get a 12-lead now and continuous telemetry. Repeat ECG during symptoms or after another event. History…
BRASH Syndrome
Key Points BRASH is a synergistic spiral: bradycardia, renal failure, therapeutic AV-nodal blockade, shock, and hyperkalemia. The signature clue is disproportionate brady-shock despite only modest potassium elevation. Do not be…
Wolff-Parkinson White (WPW) Syndrome
Key Points Pattern vs syndrome: WPW pattern = pre-excitation on ECG without symptoms. WPW syndrome = pattern plus tachyarrhythmia symptoms (palpitations, syncope, “seizure,” aborted sudden cardiac arrest). Mechanism: Congenital accessory…
ECG Findings in Tension Pneumothorax
Key Points Tension pneumothorax is a clinical diagnosis—ECG changes are nonspecific but can provide supportive evidence in the right context. Electrical changes are primarily due to mechanical effects of air…
ECG Findings in Aortic Dissection
Key Points Aortic dissection or aneurysm can produce ischemic‑appearing ECGs due to coronary malperfusion, most often right coronary involvement causing inferior changes. Pseudo‑infarction patterns, ST‑deviation, and conduction blocks can occur…
Ventricular Flutter
Key Points Definition: A malignant ventricular tachyarrhythmia with a regular, sine-wave–like waveform at ~250–350 bpm, with no isoelectric baseline and no clear P/QRS/T distinction. Why it matters: Rapidly degenerates to…
Hyperacute T Waves (OMI Pattern)
Key Points Complexity of ACS: Arteries can spontaneously reperfuse or re-occlude. Understanding early ECG patterns of early acute ischemia can help detect dynamic changes and prompt rapid interventions. ECG Pattern…
Dysrhythmias in LVAD Patients
Key Points Continuous-flow LVADs can mask shock: patients may talk through VT/VF because pump flow maintains some perfusion. Treat the rhythm, not the appearance. First steps in any unstable LVAD…
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Key Points Rare, inherited ventricular arrhythmia triggered by adrenergic stress during exertion or emotion. Classically presents in children or adolescents with syncope or cardiac arrest despite a normal resting ECG…
Takotsubo Cardiomyopathy vs. STEMI
Key Points Takotsubo (stress) cardiomyopathy is a transient, non-ischemic LV dysfunction—classically apical ballooning with basal hyperkinesis—often after emotional or physical stress. Presentation mimics occlusion MI (chest pain, ECG changes, elevated…
Metabolic Emergencies
Key Points A Simple Yet Powerful Tool: With just a piece of paper and some ink, the ECG can be the earliest clue to life-threatening metabolic disease when labs are…
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