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Occlusion MI – STEMI Criteria & Beyond
Key Points A STAT ECG is the most important initial test in patients with suspected acute coronary syndrome (ACS), enabling rapid identification of acute coronary occlusion myocardial infarction (OMI), a…
Aslanger Pattern (OMI Pattern)
Key Points STEMI Diagnosis and Contiguous Leads: While current guidelines typically require ST elevation (STE) in at least two contiguous leads for the diagnosis of STEMI, this practice is not…
Precordial Swirl (OMI Pattern)
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…
High-Risk Pulmonary Embolism
Key Points High-Risk PE: High-risk pulmonary embolism (PE) is a life-threatening condition requiring immediate recognition and treatment. The ECG can provide early, life-saving clues in the diagnosis of high-risk PE. Critical…
Pericardial Tamponade
Key Points Beyond Electrical Alternans: Although classically linked to tamponade, electrical alternans is present in fewer than 30% of confirmed cases. It’s abscence should never rule out tamponade. Low Voltage…
Post-Cardiac Arrest ECGs
Key Points Coronary Occlusion After Shockable Arrest: ~30% of patients resuscitated from ventricular fibrillation (VF) arrest have an acute coronary occlusion and present with STEMI on ECG. Among patients without…
Electrical Alternans
Key Points Classically associated with pericardial tamponade but seen in fewer than 30% of confirmed cases. Combination of low-voltage QRS + sinus tachycardia strongly suggests pericardial effusion/tamponade. Always perform rapid…
Torsades de Pointes (TdP)
Key Points Definition: TdP is a specific subtype of polymorphic ventricular tachycardia associated with a prolonged QTc interval. It often presents with a “twisting” pattern on ECG but can be…
Polymorphic Ventricular Tachycardia (PMVT)
Key Points Definition: PMVT is a ventricular tachycardia characterized by beat-to-beat variations in QRS morphology, axis, and duration, reflecting multiple ventricular foci or reentrant circuits. Clinical Importance: PMVT is often…
Computer Interpreted “Normal” ECGs
Key Points Do not fully trust computer interpretations of “normal” ECGs—they may miss significant abnormalities. Computer algorithms can miss early ischemic signs such as reciprocal changes in aVL and hyperacute…
Posterior STEMI Criteria
Key Points High Risk of Missed Diagnosis: Isolated posterior occlusion MI is frequently missed due to the absence of ST elevation on standard 12-lead ECG. Instead, ST depression in V1–V3…
Ventricular Fibrillation (VF)
Key Points Rapidly Fatal Rhythm: VF is the most critical shockable cardiac arrest rhythm, requiring immediate defibrillation and high-quality CPR to prevent sudden cardiac death within minutes. Chaotic Electrical Activity:…
AV Block: Third-Degree (Complete Heart Block)
Key Points Definition: Complete heart block (CHB) involves complete failure of conduction from atria to ventricles, resulting in independent atrial and ventricular rhythms (AV dissociation). Hallmark ECG Features: AV Dissociation:…
ST Depression V1-V4 (Posterior OMI Pattern)
Key Points Most Missed STEMI: Isolated posterior MI is the most commonly missed occlusion MI due to the absence of ST elevation on standard 12-lead ECG. ECG Pattern of Posterior…
Sodium Channel Blocker Toxicity
Key Points Recognizing the Danger: Sodium channel blocker toxicity can present with a variety of ECG changes that are critical to recognize, especially in patients with altered mental status or…
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…
Unstable Tachyarrhythmias
Key Points: Immediate Risk: Unstable tachyarrhythmias pose a significant risk for rapid clinical deterioration, leading to irreversible end-organ damage or cardiac arrest. Clinical Indicators of Instability: Altered Mental Status: confusion,…
Monomorphic Ventricular Tachycardia
Key Points Most Common Form: Monomorphic VT is the most frequent type of sustained ventricular tachycardia. Rate: Typically regular, rapid heart rate (>120-130 bpm). Be cautious of mimics when rate…
Syncope Emergencies
Key Points Cardiac Syncope and ECG: Cardiac syncope can mimic seizures, making it essential to obtain a 12-lead ECG in patients with near-syncope or a first-time “seizure” to screen for…
Ventricular Tachycardia (VT)
Key Points Definition: VT is a wide complex tachycardia arising from the ventricles, defined as ≥3 consecutive ventricular beats, QRS duration >120 ms, with rapid heart rate typically 120-250 bpm….
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