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Post-Cardiac Arrest ECGs
Key Points Coronary Occlusion After Shockable Cardiac Arrest: ~30% of patients resuscitated from ventricular fibrillation (VF) arrest have an acute coronary occlusion and present with STEMI on ECG ~ 70%…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…
Modified Sgarbossa Criteria
Key Points Diagnosis in LBBB and RV Pacing: Left bundle branch block (LBBB) and RV-paced rhythms can mask acute myocardial infarction (MI). However, specific ECG criteria, including the Smith-Modified Sgarbossa…
Wolff-Parkinson White (WPW) Syndrome
Key Points Ventricular Pre-excitation: Occurs due to a congenital accessory pathway bypassing the AV node, leading to early ventricular activation. Commonly associated with Wolff-Parkinson-White (WPW) syndrome when symptomatic. WPW Complications:…
Atrial Fibrillation with WPW
Key Points WPW Syndrome: A condition characterized by ventricular pre-excitation due to a congenital accessory pathway, often associated with symptomatic arrhythmias. ECG Recognition: The WPW pattern is best identified when…
Electrical Alternans
Key Points Electrical alternans is classically associated with pericardial tamponade but occurs in fewer than 30% of confirmed cases. Low voltage QRS and sinus tachycardia combined raise suspicion for a…
Wellens Syndrome
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…
OMI Patterns in Ventricular Paced Rhythms
Key Points Paced Rhythms and MI Detection: Ventricular paced rhythms alter ST-segment and T-wave morphology, making the detection of acute myocardial infarction (MI) more complex compared to native conduction systems….
Subtle ST Segment Elevation (OMI Pattern)
Key Points ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…
Hyperacute T Waves (OMI Pattern)
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:…
de Winter T Waves (OMI Pattern)
Key Points STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). This pattern…
South African Flag Sign (OMI Pattern)
Key Points Pattern Recognition: The South African Flag Sign is characterized by: ST-segment elevation (STE) in leads I, aVL, and V2. ST-segment depression in lead III. Subtle but visually distinctive…
ST Depression V1-V4 (OMI Pattern)
Key Points Isolated posterior occlusion MI is the most commonly missed “STEMI.” ST elevation is typically not seen on the standard 12-lead ECG in isolated posterior STEMI. Instead, it manifests…
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…
OMI Patterns in Left Bundle Branch Block
Key Points Diagnosis in LBBB: LBBB does not exclude the diagnosis of occlusion myocardial infarction (OMI). Acute MI can be identified despite the repolarization changes that LBBB causes, particularly with…
Early Reciprocal Changes (OMI Pattern)
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…
New RBBB and LAFB in ACS (OMI Pattern)
Key Points Pattern Recognition: New-onset Right Bundle Branch Block (RBBB) and Left Anterior Fascicular Block (LAFB) occurring together is a high-risk ECG finding. Often associated with proximal Left Anterior Descending…
Precordial Swirl (OMI Pattern)
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment elevation across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). Mechanism: This…
Acute Pericarditis vs. STEMI
Key Points Acute Pericarditis: A challenging diagnosis with symptoms and ECG findings that may mimic STEMI. STEMI: A more life-threatening and time-sensitive condition. Differentiation from pericarditis is crucial to avoid…
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