Key Points Dynamic Nature of ACS: Acute coronary syndromes (ACS) are complex and dynamic, with coronary arteries potentially undergoing reperfusion and reocclusion at any time. The ECG can provide real-time…
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…
Key Points Traditional STEMI Criteria Alone Miss Acute Coronary Occlusion MI: Widely used but insufficiently sensitive or specific, many genuine occlusions (OMIs) do not meet strict STEMI criteria. Current Guidelines…
Key Points Complexity of ACS: Arteries can spontaneously reperfuse or re-occlude. Understanding early ECG patterns of acute ischemia can help detect dynamic changes and prompt rapid interventions. ECG Pattern Recognition:…
Key Points ACS Dynamics: ACS is complex and dynamic, with occluded arteries potentially reperfusing and reoccluding at any time. ECG Pattern Recognition: Mastering ECG pattern recognition in ACS is crucial…
Key Points A STAT ECG is the most critical first test in patients with suspected acute coronary syndrome (ACS). It allows for early identification of acute coronary occlusion myocardial infarction…
Key Points The ECG Chameleon: Severe hyperkalemia can produce ST segment elevations, wide QRS complexes, and conduction delays that closely resemble STEMI or ventricular tachycardia. Early misinterpretation can lead to…
Key Points Wide QRS & Repolarization Abnormalities: Bundle branch blocks (BBBs) and ventricular-paced rhythms (RV, LV, BiV) cause abnormal ventricular depolarization, leading to secondary ST segment and T wave changes—even…
Key Points 1. Paced Rhythms and Acute MI Detection: Ventricular paced rhythms significantly alter ST segment and T wave morphology, complicating acute myocardial infarction (MI) recognition. Accurate ECG interpretation in…
Key Points LBBB Does Not Exclude Acute Coronary Occlusion: LBBB alters ventricular activation, leading to expected secondary ST/T abnormalities. However, acute occlusion myocardial infarction (OMI) can and must still be…
Key Points Wide QRS Rhythms Can Mask OMI: Left bundle branch block (LBBB) and right ventricular (RV)-paced rhythms alter ventricular depolarization, producing expected secondary ST/T changes. However, acute occlusion MI…
Key Points What It Is: A rare autosomal dominant sodium channelopathy that leads to episodic muscle weakness or paralysis in the setting of elevated serum potassium. Named after “Impressive,” the…
Key Points Spectrum of Arrhythmias: Sinus node dysfunction produces alternating periods of inappropriate bradycardia (sinus bradycardia, pauses, arrest) and paroxysmal atrial tachyarrhythmias (AF, atrial flutter, atrial tachycardia). Symptom Driver: Transient…
Key Points Diagnosis: Wellens syndrome is a clinical diagnosis that requires more than just the presence of Wellens waves; it necessitates a thorough history and consideration of other potential causes…
Key Points Definition: Atrial fibrillation with a slow ventricular response, usually < 60 bpm. ECG: Irregularly irregular rhythm, no discrete P waves, slow R-R intervals. Common causes: AV-nodal blockers (digoxin,…
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…
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…
Key Points Narrow therapeutic window: Small dosing errors or renal decline can push serum digoxin above the safe range. Excess automaticity + AV block: Toxicity increases atrial and ventricular irritability…
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…
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…
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