Life Savers
Latest
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…
STEMI vs Acute Pericarditis: DDx
Key Points: Start by looking for STEMI, not pericarditis. The safest workflow is to actively search for occlusion MI features first, then use pericarditis features as supportive evidence. Reciprocal ST…
Traditional STEMI Criteria (Millimetric Thresholds)
Key Points: STAT ECG is the first decision point in ACS. The primary purpose of the initial ECG is to identify patients who meet traditional STEMI criteria and require immediate…
ST Depression V1-V4: OMI Pattern
Key Points: Most missed occlusion MI. Isolated posterior occlusion MI is frequently missed because the standard 12-lead ECG often lacks ST elevation. Instead, posterior injury appears as reciprocal anterior ST…
STEMI vs Takotsubo Cardiomyopathy: DDx
Key Points: Takotsubo (stress) cardiomyopathy is a transient, non-ischemic LV dysfunction—classically apical ballooning with basal hyperkinesis—often after emotional or physical stress. Presentation mimics occlusion MI (chest pain, ECG changes, elevated…
Earliest Evidence of Occlusion MI
Key Points ACS is dynamic. Coronary arteries can occlude, partially reperfuse, and re-occlude over minutes to hours, and the ECG can show these shifts before biomarkers do. The earliest actionable…
Post-Thrombolytic Reperfusion ECG Findings
Key Points Reperfusion after fibrinolysis is a bedside diagnosis using a bundle of findings: symptoms, ECG trend, and hemodynamic/electrical stability. Best ECG marker of successful fibrinolysis: at least 50% ST-segment…
ECG Evidence of Reperfusion After Occlusion
Key Points Reperfusion and re-occlusion can occur spontaneously or after therapy. The ECG often reflects these changes earlier than symptoms. Most useful bedside ECG marker of reperfusion is ST-segment resolution…
Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Spiked Helmet Sign (SHS)
Key Points SHS is a rare ECG pattern of pseudo–ST elevation that begins before the QRS complex, producing a dome-and-spike contour resembling a Prussian/German spiked helmet. SHS strongly correlates with…
de Winter T Waves: STEMI Equivalent 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). Treat the…
New RBBB and LAFB (Bifascicular Block) in ACS
Key Points Think proximal LAD / septal ischemia until proven otherwise when a patient with ischemic symptoms develops new RBBB + LAFB, especially with hemodynamic instability. Do not “normalize” ST…
High-Risk Pulmonary Embolism
Key Points: The ECG can provide early clues to high-risk PE and may identify patients at risk for rapid hemodynamic collapse. Right ventricular strain patterns are the core high-risk markers….
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
Himalayan T Waves
Key Points Tall, broad-based T–U fusion that looks like a mountain peak, usually from severe hypokalemia; think high torsades risk until proven otherwise. Hallmark is prolonged repolarization: QT appears long…
Pediatric ECG Red Flags
Key Points Any wide QRS (>90 ms) in an infant or small child is abnormal and should trigger evaluation for VT, sodium-channel blockade, or conduction disease. QTc >450 ms in…
Pediatric ECG in Cardiac Arrest
Key Points ECG rhythms in pediatric arrest differ from adults. Pulseless arrest in children is most often asphyxial, but ECG clues can reveal reversible metabolic, toxicologic, or structural causes. Wide…
Pseudo-Wellens Waves
Key Points: Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Wellens Syndrome
Key Points: Clinical diagnosis, not an ECG pattern alone. Wellens syndrome requires the characteristic ECG findings plus the appropriate clinical scenario. Morphology alone is insufficient and high-risk if misapplied. Critical…
Torsade de Pointes (TdP)
Key Points Definition: TdP is a specific subtype of polymorphic ventricular tachycardia associated with a prolonged QTc interval. It often presents with a “twisting” pattern on ECG but can be…
Free Content
Jump on our email list for free tips and insights delivered to your inbox monthly. No spam - just quick pearls and ECG education.
Categories
- No categories
© 2026 ECG Weekly. All rights reserved. | Terms of Use | Privacy Policy
Powered by the member(dev) platform
Loading...