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ECG Evidence of Reperfusion After Occlusion
Key Points Dynamic Nature: Coronary artery occlusions can spontaneously reperfuse or re-occlude, causing rapidly changing ECG patterns. Real-Time ECG Utility: Recognizing reperfusion ECG patterns allows early identification of successful artery…
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…
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…
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…
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…
Brugada Syndrome (BrS)
Key Points Life-Threatening Sodium Channelopathy: Predisposes to ventricular arrhythmias (VF/VT) and sudden cardiac death (SCD), often in otherwise “healthy” hearts. When to Suspect BrS: Patients with syncope, unexplained “seizures,” ventricular…
Hypokalemic Periodic Paralysis
Key Points Definition: A rare ion channelopathy that causes sudden, reversible episodes of symmetric flaccid paralysis triggered by low serum potassium. It may be inherited or secondary to thyrotoxicosis or…
R on T Phenomenon
Key Points The R on T phenomenon occurs when an ectopic electrical impulse (often a premature beat or cardioversion shock) falls on the T wave of the preceding beat. Interrupting…
ST Elevation in aVR with Diffuse ST Segment Depression
Key Points Global Subendocardial Ischemia: ST elevation in aVR, combined with diffuse ST depression in multiple other leads, reflects global subendocardial ischemia of the left ventricle. This pattern is associated…
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…
WPW Syndrome and Pseudo-MI patterns
Key Points WPW Pattern Mimics: Wolff-Parkinson-White (WPW) syndrome can produce an ECG pattern that mimics conditions such as myocardial infarction, ventricular bigeminy, accelerated idioventricular rhythm, and electrical alternans. ST Segment…
Hyperkalemia Emergencies
Key Points Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Hyperkalemia can produce a wide range of ECG abnormalities that resemble unstable brady and tachy arrhythmias, STEMI, and can also cause pacemaker…
STEMI (-) Occlusion MI Patterns
Key Points Traditional STEMI Criteria: Widely used but insufficiently sensitive or specific—some genuine occlusions do not meet these thresholds. 2022 ACC Guidelines: While the guidelines uphold emergent reperfusion for classic…
Metabolic Emergencies
Key Points A Simple Yet Powerful Tool: With just a piece of paper and some ink, the ECG can unveil life-threatening metabolic emergencies, giving you the power to detect critical…
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…
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