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Hypokalemic Periodic Paralysis
Key Points Definition: A rare channelopathy characterized by episodes of profound muscle weakness or paralysis when serum potassium levels drop. Common Triggers: High-carbohydrate meals, strenuous exercise, hyperthyroidism (thyrotoxic periodic paralysis),…
Hyperkalemic Periodic Paralysis – “Impressive Syndrome”
Key Points Definition: A rare autosomal dominant channelopathy (1 in 200K humans) that leads to severe muscle weakness or paralysis due to elevated serum potassium. Common Triggers: Missed dialysis, potassium-rich…
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…
Hyperkalemia vs. STEMI
Key Points ECG Chameleon: Hyperkalemia can mimic STEMI or wide-complex tachyarrhythmias, leading to diagnostic confusion. Right Axis Deviation (RAD): An uncommon finding in acute STEMI but frequently seen in hyperkalemia….
BBBs & Paced Rhythms vs. STEMI
Key Points Wide QRS Complexes & ST/T Wave Abnormalities: Bundle branch blocks (BBBs) and paced rhythms, which cause depolarization abnormalities, will often present with ST segment and T wave abnormalities…
ST Segment Elevation in aVR with Multi Lead 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 can mimic unstable bradyarrhythmias that resist standard ACLS interventions. It can produce extremely wide QRS complexes and bizarre rhythms that appear identical to ventricular tachycardia (VT)….
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…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points Definition & Terminology Arrhythmogenic Cardiomyopathy (ACM) is an inherited disorder marked by progressive replacement of ventricular myocardium (primarily RV) with fibrofatty tissue. Formerly called Arrhythmogenic Right Ventricular Cardiomyopathy…
Spiked Helmet Sign (SHS)
Key Points The Spiked Helmet Sign (SHS) is a rare but important ECG pattern characterized by pseudo ST-segment elevation that starts before the onset of the QRS complex. SHS is…
Pacemaker Emergencies
Key Points: Common Emergencies: Pacemaker failures can be categorized into failure to pace, failure to capture, and failure to sense. ECG Clues: Look for absent pacer spikes (failure to pace),…
STEMI Mimics
Key Points Contextual Interpretation: The accuracy of ECG interpretation depends on the pretest probability for the condition being evaluated. ECGs should always be interpreted in the context of the clinical…
LVH vs. STEMI
Key Points LVH Mimicry: Left ventricular hypertrophy (LVH) can mimic anterior coronary occlusion and is a common cause of “false-positive” cath lab activations. Diagnostic Challenge: LVH with strain pattern can…
Hypokalemia Emergencies
Key Points Severe hypokalemia can produce dramatic ECG changes that may be mistaken for acute coronary syndromes. Life-threatening arrhythmias, including torsades de pointes and ventricular tachyarrhythmias, can occur if severe…
Early Repolarization vs. STEMI
Key Points Differentiation Challenge: Early repolarization (ER) is a benign ECG pattern often seen in healthy young individuals, characterized by ST segment elevation that can mimic STEMI and acute pericarditis….
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…
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