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Altered Mental Status Emergencies
Key Points Always get a 12-lead ECG in AMS. It can reveal reversible, life-threatening causes when history is limited. Think categories: ischemia, electrolytes, tox, and perfusion rhythms. Act on what…
Artifact vs. Ventricular Rhythms
Key Points Artifact is a common source of misdiagnosis for serious arrhythmias such as polymorphic ventricular tachycardia (PVT), torsades de pointes, or ventricular fibrillation (VF). Always correlate the ECG findings…
Pacemaker Emergencies
Key Points: Three core malfunctions: failure to pace (no spike when needed), failure to capture (spike without depolarization), failure to sense (spike at the wrong time). Each has a distinct…
Monomorphic Ventricular Tachycardia (MMVT)
Key Points MMVT is the most common sustained VT. It shows a single, uniform QRS morphology throughout. Classified as sustained if lasting > 30 seconds or associated with hemodynamic instability….
Ventricular Tachycardia (VT): Core Overview
Key Points VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
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…
Artifact vs. STEMI
Key Points Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
Shark Fin (Triangular QRS–ST–T) STEMI Pattern
Key Points High-risk STEMI morphology caused by fusion of the terminal QRS, J point, ST segment, and T wave into a single “triangular” deflection. Often massive apparent STE with loss…
VT vs SVT with Aberrancy
Key Points ECG alone cannot reliably distinguish VT from SVT-aberrancy in many cases. Use ECG features to rule in VT, not to exclude it. Default: treat regular WCT as VT…
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…
Bidirectional Ventricular Tachycardia (BiVT)
Key Points BiVT is a regular wide-complex VT with beat-to-beat alternation of QRS axis and/or bundle-branch pattern (often alternating RBBB/LBBB or 180° frontal-plane axis shift). Most common cause is severe…
RV Outflow Tract Tachycardia (RVOT VT)
Key Points Idiopathic monomorphic VT arising from the right ventricular outflow tract. Most patients have no structural heart disease; catecholamine and cAMP-mediated triggers are common. Classic ECG pattern: LBBB morphology…
Hypokalemia Emergencies
Key Points Severe hypokalemia can produce dramatic ECG changes that may be mistaken for acute coronary syndromes. It can also precipitate life-threatening arrhythmias, including torsades de pointes and ventricular tachyarrhythmias…
Fascicular Ventricular Tachycardia (Idiopathic Left Fascicular VT)
Key Points Idiopathic reentrant VT arising within the left Purkinje system, most often the left posterior fascicle. Patients are usually young and lack structural heart disease. Signature ECG: RBBB-like morphology…
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…
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…
Opiate Toxicity
Key Point Opioid overdose causes life-threatening respiratory depression leading to hypoxia, altered mental status, bradycardia, hypotension, and potentially death. While most cardiovascular effects are secondary to hypoxia, methadone toxicity uniquely…
Methamphetamine Toxicity
Key Point Methamphetamine is a powerful sympathomimetic that causes a massive catecholamine surge, it can result in life-threatening cardiovascular and neurologic complications. Toxicity can present with MI, arrhythmias, stroke, hypertensive…
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….
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