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Second-Degree AV Block with 2:1 Conduction
Key Points Definition: A form of second-degree AV block in which every other atrial impulse is blocked, producing a 2:1 atrioventricular conduction ratio. Typing Limitation: Differentiating between Mobitz I and…
Second-Degree AV Block Type II (Mobitz II)
Key Points Definition: Sudden failure of AV conduction after at least two consecutive conducted beats with identical PR intervals, followed by a single non‑conducted P wave. Sinus rate: P–P interval…
Ventricular Tachycardia (VT) Mimics
Key Points Initial Assumption: Any wide (QRS >120 ms), regular tachycardia should be considered ventricular tachycardia (VT) until clearly proven otherwise. VT Characteristics: VT generally has a ventricular rate of…
Cannabis (Marijuana) Toxicity
Key Point Cannabis use is rapidly increasing due to legalization and broader acceptance, both recreationally and medically. While causation is unproven, multiple observational studies suggest associations with acute cardiovascular events,…
Toxicologic Emergencies
Key Point ECG as a Critical Diagnostic Tool: The ECG is often the first and most reliable clue in toxicology. Early recognition of drug-induced conduction disturbances or arrhythmias can guide…
Terminal QRS Distortion (OMI Pattern)
Key Points What it is: In V2 or V3, there is no S wave (the R does not descend below the PQ baseline) and no J wave (no notch/slur at…
Digoxin Toxicity
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…
VT vs. SVT with Aberrancy
Key Points Basic Distinction: SVTs typically have narrow QRS complexes (<120 ms) but may present with wide complexes if aberrantly conducted (e.g., with existing bundle branch block). Clinical Importance: Differentiating…
LV Aneurysm vs. STEMI
Key Points Left Ventricular Aneurysm (LVA): Causes persistent ST elevation lasting more than 2 weeks post-MI, typically seen in the anterior leads but can also affect the inferior leads. Occurs…
Severe Hypothermia
Key Points Hypothermia and the ECG: Severe hypothermia produces characteristic ECG changes that reflect slowed conduction and heightened arrhythmia risk. Recognition is crucial for diagnosis and safe management. Osborne Waves…
Fascicular Ventricular Tachycardia
Key Points Definition: Fascicular VT is an idiopathic re-entrant tachycardia arising from the fascicles of the left bundle branch (LBB) within the Purkinje system. Mechanism: Re-entry within the Purkinje network,…
Atrial Flutter 1:1 Conduction
Key Points Rare, dangerous presentation. When atrial flutter conducts 1:1 through the AV node (or an accessory pathway), the ventricular rate can approach the atrial rate ~240–320 bpm, producing rapid…
Earliest Evidence of Occlusion MI
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…
Computer Interpreted “Normal” ECGs
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…
STEMI (-) Occlusion MI Patterns
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…
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…
Occlusion MI: STEMI Criteria & Beyond
Key Points A STAT ECG is the most critical first test in suspected acute coronary syndrome (ACS). It allows for early recognition of acute coronary occlusion myocardial infarction (OMI), a…
STEMI vs. Severe Hyperkalemia
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…
STEMI vs Wide QRS (BBBs & Paced Rhythms)
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…
Occlusion MI Patterns in Ventricular Paced Rhythms
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…
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