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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…
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Key Points Definition: HOCM is a genetic cardiomyopathy characterized by abnormal thickening of the left ventricle, most often the interventricular septum, leading to dynamic outflow obstruction. Epidemiology: HOCM is the…
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…
Syncope Emergencies
Key Points ECG Everytime: Cardiac syncope can mimic seizures. In first-time “seizure,” near-syncope, or unexplained LOC, get a 12-lead ECG early and monitor the patient on telemetry. Small clues, big…
Inverted U waves
Key Points Definition: A negative deflection after the T wave (a true U wave) that is ≥0.5 mm deep in a lead where the T wave is upright. Why it…
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…
Electrical Storm
Key Points Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate shocks from an implantable cardioverter-defibrillator (ICD) within 24…
Beta-Blocker and Calcium Channel Blocker Toxicity
Key Point BBs and CCBs are widely prescribed but overdoses can cause life-threatening bradycardia, AV block, hypotension, and shock. Differentiating between them is important, but both require early recognition, aggressive…
Cocaine Toxicity
Key Point Cocaine is a powerful sympathomimetic with profound cardiovascular (CV) effects. Even recreational or first-time use can precipitate life-threatening complications, including myocardial infarction (MI), stroke, arrhythmias, and aortic dissection….
Isorhythmic AV Dissociation
Key Points Definition: A type of AV dissociation in which sinus and escape rates are nearly identical, so P waves and QRS complexes appear to “track” each other while remaining unrelated….
Third-Degree AV Block (Complete Heart Block)
Key Points Definition: Third-degree AV block is complete failure of conduction from atria to ventricles, resulting in independent atrial and ventricular activity—known as AV dissociation. Hallmark Feature: No P waves…
High-Grade (Advanced) AV Block
Key Points Definition: A severe form of second-degree AV block with two or more consecutive non‑conducted P waves (for example 3:1, 4:1). Do not force a Mobitz label when multiple…
Slow Ventricular Tachycardia (VT)
Key Points Definition: Slow ventricular tachycardia is defined as a wide complex tachycardia with a ventricular rate between 100–120 bpm. Distinction: Typical sustained VT usually exceeds 120 bpm. When encountering…
R-on-T Phenomenon
Key Points Definition: The R on T phenomenon occurs when an ectopic impulse (often a PVC or cardioversion shock) falls on the T wave of the preceding beat. Mechanism: Interrupting…
Critical ECG Emergencies
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…
STEMI Mimics
Key Points Context Matters: ECGs must be interpreted in the clinical setting. Chest pain, shock, or ACS risk factors increase pretest probability of STEMI/OMI, while atypical presentations lower it. Prevalence:…
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….
STEMI Criteria & Equivalent Patterns
Key Points ECG are a Critical Tool: ECGs are the most important initial test in evaluating acute coronary syndromes (ACS). The primary goal is to quickly identify patients with acute…
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:…
Second-Degree AV Block Type I (Mobitz I/Wenckebach)
Key Points Definition: Progressive PR interval prolongation until one atrial impulse fails to conduct to the ventricles (P wave is non-conducted), after which the cycle repeats. Site of Block: Typically…
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