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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), 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 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),…
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….
Upright T waves in V1
Key Point Normal T Wave in V1: The normal ECG typically shows a flat or inverted T-wave in lead V1. Upright T-Wave Abnormality: An upright T-wave in V1 (TV1) should…
WPW with Antidromic SVT
Key Points WPW Syndrome: Wolff-Parkinson-White (WPW) syndrome is a condition characterized by ventricular pre-excitation due to a congenital accessory pathway in patients with symptomatic arrhythmias. ECG Recognition: The classic WPW…
WPW with Orthodromic SVT
Key Points WPW Syndrome: Wolff-Parkinson-White (WPW) syndrome is a condition where ventricular pre-excitation occurs due to a congenital accessory pathway in patients with symptomatic arrhythmias. ECG Recognition: The WPW ECG…
Opiate Toxicity
Key Point Opioid overdose causes life-threatening respiratory depression leading to hypoxia, altered mental status, bradycardia, hypotension, and potentially death. While most cardiovascular effects are secondary to hypoxia, methadone toxicity uniquely…
Methamphetamine Toxicity
Key Point Methamphetamine is a powerful sympathomimetic that causes a massive catecholamine surge, it can result in life-threatening cardiovascular and neurologic complications. Toxicity can present with MI, arrhythmias, stroke, hypertensive…
Takotsubo Cardiomyopathy vs. STEMI
Key Points Definition and Context: Also known as Takotsubo syndrome, stress cardiomyopathy, or “broken heart syndrome,” this is a non-ischemic cardiomyopathy characterized by transient wall motion abnormalities of the LV…
Altered Mental Status Emergencies
Key Points Altered Mental Status (AMS) and ECG: In patients presenting with altered mental status, the ECG can be an invaluable tool for uncovering life-threatening underlying causes, including metabolic disturbances,…
Right Ventricular (RV) STEMI Criteria
Key Points Prevalence: Up to 40% of inferior STEMIs extend to the right ventricle (RV), though isolated RV infarction is rare. Identifying RV MI is critical due to its unique…
Dysrhythmia in LVADs
Key Points Ventricular Fibrillation in LVADs: Ventricular fibrillation (VF) in patients with Left Ventricular Assist Devices (LVADs) can be rapidly fatal but is often better tolerated initially due to the…
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