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Wolff-Parkinson White (WPW) Syndrome
Key Points: Pattern vs syndrome: WPW pattern is ECG evidence of pre-excitation without symptoms. WPW syndrome is pattern plus symptomatic tachyarrhythmia (palpitations, syncope, “seizure”, aborted sudden cardiac arrest). PR interval…
WPW Syndrome and Pseudo-MI Patterns
Key Points: WPW alters ventricular depolarization, producing secondary repolarization abnormalities that can mimic or mask myocardial infarction. ST-segment deviation in WPW is often non-ischemic, driven by abnormal activation via the…
Atrial Fibrillation with WPW (Pre-excited AF)
Key Points: Pre-excited AF is the most dangerous WPW rhythm. It can deteriorate quickly to VF because the accessory pathway may conduct atrial impulses to the ventricle at extreme rates….
WPW with Antidromic SVT (Antidromic AVRT)
Key Points: Antidromic AVRT is an AV re-entrant tachycardia that conducts antegrade down the accessory pathway and returns retrograde through the AV node (or another pathway), producing a regular wide-complex…
WPW with Orthodromic SVT (Orthodromic AVRT)
Key Points: Orthodromic AVRT is the most common tachyarrhythmia in WPW and presents as a regular narrow-complex SVT that is indistinguishable from AVNRT during the tachycardia. Mechanism: antegrade conduction down…
The Life Savers: Critical ECG Pattern Hub
Key Points: Critical ECG patterns represent time-sensitive, life-threatening cardiac or systemic conditions that demand immediate recognition to prevent death or irreversible organ injury. These are the “can’t-miss” ECGs. Use this…
Bidirectional Ventricular Tachycardia (BiVT)
Key Points: BiVT is a regular wide-complex tachycardia with strict beat-to-beat alternation of QRS axis and/or bundle-branch pattern (often an approximately 180° frontal-plane axis flip). In adults, assume digoxin toxicity…
Occlusion MI: STEMI Criteria & Beyond
Key Points: The ECG’s primary role in ACS is detecting acute coronary occlusion. Acute coronary occlusion myocardial infarction (OMI) is a time-critical diagnosis that requires immediate reperfusion. Time is myocardium….
STEMI (-) Occlusion MI: OMI Patterns
Key Points: Traditional STEMI criteria miss many acute coronary occlusions. A substantial proportion of true OMIs do not meet classic millimetric STEMI thresholds. OMI is a pathophysiologic diagnosis, not an…
STEMI in the Presence of Baseline ECG Abnormalities
Key Points: Baseline ECG abnormalities do not protect patients from occlusion MI. They increase miss rates because they distort the ST segment and T waves. The core question is not…
Lateral and High-Lateral STEMI: Criteria, Localization, and Pitfalls
Key Points: Lateral and high-lateral STEMI often present with subtle ST elevation and are commonly missed or labeled as nonspecific ST-T changes. Small-appearing ECG changes may represent true coronary occlusion…
Inferior STEMI: Criteria, RV Involvement, and Pitfalls
Key Points: Inferior STEMI is the most common STEMI subtype and is frequently complicated by right ventricular and posterior involvement. Inferior occlusion may present with classic ST elevation, subtle ischemic…
Anterior STEMI: Criteria, Localization, and Pitfalls
Key Points: Anterior STEMI represents large myocardial territory at risk and carries the highest mortality among STEMI subtypes. Early recognition and reperfusion are critical. LAD occlusion may present with classic…
Posterior STEMI: Criteria & Pitfalls
Key Points: High risk of missed diagnosis. Isolated posterior occlusion MI is frequently missed because ST elevation is absent on the standard 12-lead ECG. Instead, posterior infarction most often presents…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is a common, benign ECG pattern that most often appears in young, healthy patients. It can closely resemble acute anterior STEMI, creating a high-risk diagnostic…
STEMI vs LV Aneurysm: DDx
Key Points: LV aneurysm pattern is a post MI scar pattern with persistent ST elevation in the prior infarct territory, usually with pathologic Q waves and a stable, non evolving…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points: Pattern, not a STEMI equivalent. ST elevation in aVR (≥1 mm), often with ST elevation in V1 and diffuse ST depression (≥1 mm in ≥6 leads), represents high-risk…
STEMI Mimics: DDx
Key Points: ST elevation is a pattern, not a diagnosis. STEMI represents one cause of ST elevation and requires correlation with ECG morphology, distribution, evolution, and clinical context. Most ED…
Hyperkalemia Emergencies
Key Points: Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Severe hyperkalemia is one of the most dangerous ECG mimics in emergency medicine. It can resemble unstable bradyarrhythmias, VT, STEMI, and pacemaker…
STEMI vs Severe Hyperkalemia: DDx
Key Points: Severe hyperkalemia is a true ECG chameleon. It can produce ST elevation, wide QRS complexes, axis shifts, and conduction blocks that closely mimic STEMI or ventricular tachycardia. New…
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