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Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition: ACM, previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly affecting the right ventricle…
Hypokalemia Emergencies
Key Points: Severe hypokalemia can result in an arrhythmia emergency. The major threat is ventricular tachyarrhythmias, including torsades de pointes, polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Severe…
Escape-Capture Bigeminy
Key Points: Definition: Escape-capture bigeminy is an uncommon rhythm in which escape beats alternate with conducted sinus capture beats, producing a repeating paired pattern. Mechanism: Sinus slowing, sinus pauses, or…
Slow Ventricular Tachycardia (VT)
Key Points: Definition: Slow VT refers to ventricular tachycardia occurring at an unusually low ventricular rate, often near or even below the conventional tachycardia threshold. There is no universally accepted…
Ventricular Tachycardia (VT) Mimics
Key Points: Default assumption: A regular wide-complex tachycardia should be considered VT until another diagnosis is more likely. Rate modifies the differential, not the diagnosis. Typical monomorphic VT is often…
ST Depression V1-V4: OMI Pattern
Key Points: Posterior OMI can hide on the standard 12-lead. Acute posterior coronary occlusion may produce no diagnostic ST elevation in the conventional leads. Instead, posterior ST elevation is seen…
S1Q3T3 Pattern
Key Points: Not a PE diagnosis: S1Q3T3 is classically associated with pulmonary embolism, but it is neither sensitive nor specific enough to diagnose or exclude PE. Think acute right heart…
High Risk Pulmonary Embolism (PE)
Key Points: The ECG can provide an early warning of severe RV strain: No ECG finding defines high risk PE, but marked or evolving signs of acute RV pressure overload…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is one of the most common non-ischemic causes of ST elevation and one of the most frequent ECG mimics of acute anterior coronary occlusion. The…
Barcelona Criteria in Left Bundle Branch Block (LBBB): OMI Pattern
Key Points: The Barcelona Criteria are ECG criteria proposed to identify acute myocardial infarction in patients with LBBB. Core problem: LBBB causes expected secondary ST-T changes, so standard STEMI millimeter…
Aslanger Pattern: OMI Pattern
Key Points: Aslanger pattern is an OMI pattern that can identify acute inferior occlusion despite not meeting traditional STEMI criteria. The key finding is ST segment elevation isolated to lead…
Occlusion MI in Left Bundle Branch Block (LBBB): STEMI Equivalent Pattern
Key Points: LBBB does not exclude acute coronary occlusion. LBBBs produce abnormal depolarization and expected secondary ST-T changes, which can mask or mimic ischemia. Acute occlusion MI can still be…
Post-Cardiac Arrest ECGs Hub
Key Points: The first post-ROSC ECG is essential but imperfect. Obtain it immediately, but interpret it in context. Global ischemia, defibrillation, acidosis, hypothermia, vasopressors, artifact, and severe metabolic derangements can…
Post-Arrest STEMI: Cath Lab Decisions
Key Points: Persistent ST elevation after ROSC remains a guideline-supported indication for emergency coronary angiography. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends emergency angiography for patients after cardiac arrest with suspected…
Post-Arrest No STEMI: When Cath Can Wait
Key Points: Stable post-arrest patients without ST elevation should not go to reflex immediate cath solely because cardiac arrest occurred. Randomized trials in OHCA patients without ST elevation have not…
Pediatric ECG in Cardiac Arrest
Key Points: Pediatric arrest is usually respiratory, hypoxic, or shock-related, not primary coronary occlusion. The ECG still matters because it can reveal reversible metabolic, toxicologic, structural, inflammatory, or inherited electrical…
Sinus Node Dysfunction (Sick Sinus Syndrome & Bradycardia-Tachycardia Syndrome)
Key Points: A spectrum, not a single rhythm: Sinus node dysfunction includes inappropriate sinus bradycardia, sinus pauses or arrest, SA exit block, chronotropic incompetence, and alternating atrial tachyarrhythmias with bradycardia….
Sinus Arrest
Key Points: Definition: Sinus arrest occurs when the sinus node temporarily fails to generate an impulse. This produces an absence of the expected P wave and its associated QRS complex….
New RBBB + LAFB (Bifascicular Block) in ACS: OMI Pattern
Key Points: In a patient with ischemic symptoms, new RBBB + LAFB should raise concern for proximal LAD or septal ischemia until proven otherwise, especially if the patient has ongoing…
Dysrhythmias in LVAD Patients
Key Points: Continuous-flow LVADs can mask cardiovascular collapse. Patients may remain awake during sustained VT or even VF because the pump can provide temporary flow. Treat the rhythm and the…
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