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Ventricular Fibrillation (VF) Arrest
Key Points: Defibrillation First, Minimal Pauses: VF is rapidly fatal without immediate shocks and high‑quality CPR. Charge during compressions and resume compressions immediately after each shock. Chaotic Electrical Activity: VF…
Ventricular Flutter (V-Flutter)
Key Points: Definition: A malignant ventricular tachyarrhythmia with a regular, sine-wave–like waveform at ~250–350 bpm, no isoelectric baseline, and no discernible P/QRS/T distinction. Clinical importance: Rapidly degenerates into ventricular fibrillation…
Post-Cardiac Arrest ECGs
Key Points: Early post-ROSC ECGs often mislead. Obtain the first ECG immediately after ROSC, but treat it as an early snapshot, not the entire story. Post-arrest physiology, defibrillation, acidosis, and…
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…
Unstable Tachyarrhythmias
Key Points: Intervene Immediately: Unstable tachyarrhythmias pose significant risk for rapid clinical deterioration that may lead to irreversible end-organ damage or cardiac arrest. Clinical Indicators of Instability: Altered Mental Status:…
Severe Hypothermia
Key Points Severe hypothermia causes rate- and temperature-dependent ECG changes that signal high arrhythmia risk. Recognition guides safe rewarming and prevents iatrogenic VF. Osborn (J) waves may appear and typically…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
Non-Thrombotic Causes of Acute Coronary Syndrome (ACS)
Key Points: ACS ≠ Always Thrombosis: While most ACS is due to plaque rupture with thrombus formation, several important non-thrombotic causes can produce identical ECG changes, troponin elevation, and symptoms….
Cannabis (Marijuana) Toxicity
Key Point Cannabis use is rising across recreational and medical contexts. Causation is not proven, but multiple contemporary studies associate cannabis with acute cardiovascular events, including MI, stroke, arrhythmias, and…
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Key Points Definition and mechanics: Genetic hypertrophic cardiomyopathy with asymmetric LV hypertrophy, typically septal, causing dynamic LVOT obstruction from systolic anterior motion (SAM) of the mitral valve. Gradient worsens when…
Yamaguchi Pattern: Apical Hypertrophic Cardiomyopathy (ApHCM)
Key Points Definition and mechanics: Hypertrophic cardiomyopathy variant with maximal hypertrophy at the LV apex (apical HCM, ApHCM). LVOT is often not obstructed at rest; some patients have mid-ventricular obstruction…
Syncope Emergencies
Key Points: ECG and monitor early: First-time seizure, near-syncope, unexplained LOC, or syncope all get a 12-lead now and continuous telemetry. Repeat ECG during symptoms or after another event. History…
Accelerated Idioventricular Rhythm (AIVR)
Key Points: Definition: AIVR is a transient, usually benign ventricular rhythm often seen after reperfusion of an acute myocardial infarction (AMI), whether spontaneous or post-intervention (PCI or thrombolysis). Rate Differentiation:…
BRASH Syndrome
Key Points BRASH is a synergistic spiral: bradycardia, renal failure, therapeutic AV-nodal blockade, shock, and hyperkalemia. The signature clue is disproportionate brady-shock despite only modest potassium elevation. Do not be…
ECG Findings in Tension Pneumothorax
Key Points Tension pneumothorax is a clinical diagnosis—ECG changes are nonspecific but can provide supportive evidence in the right context. Electrical changes are primarily due to mechanical effects of air…
ECG Findings in Aortic Dissection
Key Points: Aortic dissection or aneurysm can produce ischemic‑appearing ECGs due to coronary malperfusion, most often right coronary involvement causing inferior changes. Pseudo‑infarction patterns, ST‑deviation, and conduction blocks can occur…
Hyperacute T Waves: OMI Pattern
Key Points: Complexity of ACS: Arteries can spontaneously reperfuse or re-occlude. Understanding early ECG patterns of early acute ischemia can help detect dynamic changes and prompt rapid interventions. ECG Pattern…
Dysrhythmias in LVAD Patients
Key Points: Continuous-flow LVADs can mask shock: patients may talk through VT/VF because pump flow maintains some perfusion. Treat the rhythm, not the appearance. First steps in any unstable LVAD…
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Key Points: Rare, inherited ventricular arrhythmia triggered by adrenergic stress during exertion or emotion. Classically presents in children or adolescents with syncope or cardiac arrest despite a normal resting ECG…
Altered Mental Status Emergencies
Key Points: Always get a 12-lead ECG in altered or confused patients. The ECG is a great triage and risk stratification tool and can reveal reversible, life-threatening causes when history…
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