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STEMI Criteria & Equivalent Patterns
Key Points ECG are a Critical Tool: ECGs are the most important initial test in evaluating acute coronary syndromes (ACS). The primary goal is to quickly identify patients with acute…
Second-Degree AV Block Type I (Mobitz I/Wenckebach)
Key Points Definition: Progressive PR interval prolongation until one atrial impulse fails to conduct to the ventricles (P wave is non-conducted), after which the cycle repeats. Site of Block: Typically…
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…
Toxicologic Emergencies
Key Points ECG as a Critical Diagnostic Tool: In toxicology, the ECG is often the first and most reliable clue. 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…
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…
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…
Occlusion MI Patterns in Left Bundle Branch Block
Key Points LBBB Does Not Exclude Acute Coronary Occlusion: LBBB alters ventricular activation, leading to expected secondary ST/T abnormalities. However, acute occlusion myocardial infarction (OMI) can and must still be…
Modified Sgarbossa Criteria
Key Points Wide QRS Rhythms Can Mask OMI: Left bundle branch block (LBBB) and right ventricular (RV)-paced rhythms alter ventricular depolarization, producing expected secondary ST/T changes. However, acute occlusion MI…
Hyperkalemic Periodic Paralysis (Impressive Syndrome)
Key Points What It Is: A rare autosomal dominant sodium channelopathy that leads to episodic muscle weakness or paralysis in the setting of elevated serum potassium. Named after “Impressive,” the…
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