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Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition & Terminology: Arrhythmogenic Cardiomyopathy (ACM), previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly…
Spiked Helmet Sign (SHS)
Key Points SHS is a rare ECG pattern of pseudo–ST elevation that begins before the QRS complex, producing a dome-and-spike contour resembling a Prussian/German spiked helmet. SHS strongly correlates with…
de Winter T Waves: STEMI Equivalent 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). Treat the…
High-Risk Pulmonary Embolism
Key Points: The ECG can provide early clues to high-risk PE and may identify patients at risk for rapid hemodynamic collapse. Right ventricular strain patterns are the core high-risk markers….
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
Himalayan T Waves
Key Points Tall, broad-based T–U fusion that looks like a mountain peak, usually from severe hypokalemia; think high torsades risk until proven otherwise. Hallmark is prolonged repolarization: QT appears long…
Pseudo-Wellens Waves
Key Points: Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Wellens Syndrome
Key Points: Clinical diagnosis, not an ECG pattern alone. Wellens syndrome requires the characteristic ECG findings plus the appropriate clinical scenario. Morphology alone is insufficient and high-risk if misapplied. Critical…
Ventricular Tachycardia (VT): Core Overview
Key Points: VT is a ventricular-origin rhythm: ≥3 consecutive ventricular beats, QRS >120 ms, rate usually 120–250 bpm. Types include monomorphic VT, polymorphic VT, torsades (PMVT with long QT), ventricular…
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…
Pulseless Ventricular Tachycardia (pVT) Arrest
Key Points: Defibrillation First, Minimal Pauses: pVT is rapidly fatal without immediate shocks and high‑quality CPR. Charge defibrillator during compressions and resume compressions immediately after each shock. pVT is a…
Shark Fin “Massive STEMI” Pattern
Key Points: High-risk STEMI morphology caused by fusion of the terminal QRS, J point, ST segment, and T wave into a single “triangular” deflection. Often massive apparent STE with loss…
Prominent Upright T Wave in V1
Key Points: Normal T Wave in V1: The normal ECG typically shows a flat or inverted T wave in lead V1 in sinus rhythm. An upright T wave in V1 can…
Electrical Storm
Key Points: Definition: Electrical storm is defined as three or more episodes of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter-defibrillator (ICD) shocks within 24 hours. Some…
Pulseless Electrical Activity (PEA) Arrest
Key Points: Definition: Organized electrical activity on ECG without a palpable pulse. PEA is a non-shockable arrest rhythm requiring CPR, epinephrine, and identification of reversible causes. Confirmation: Verify in two…
Asystole (Cardiac Arrest)
Key Points: Definition: Asystole is a non-shockable cardiac arrest rhythm characterized by absence of ventricular electrical activity. Treat with high-quality CPR, epinephrine every 3–5 minutes, and an urgent search for…
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…
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:…
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