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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…
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…
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…
Metabolic Emergencies
Key Points: A Simple Yet Powerful Tool: With just a piece of paper and some ink, the ECG can be the earliest clue to life-threatening metabolic disease when labs are…
Artifact vs Ventricular Rhythms: DDx
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…
Inverted U Waves
Key Points Definition: A negative deflection after the T wave (a true U wave) that is ≥0.5 mm deep in a lead where the T wave is upright. Why it…
STEMI vs Artifact: DDx
Key Points: Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
VT vs SVT with Aberrancy: DDx
Key Points ECG alone cannot reliably distinguish VT from SVT-aberrancy in many cases. Use ECG features to rule in VT, not to exclude it. Default: treat regular WCT as VT…
RV Outflow Tract Tachycardia (RVOT VT)
Key Points Idiopathic monomorphic VT arising from the right ventricular outflow tract. Most patients have no structural heart disease; catecholamine and cAMP-mediated triggers are common. Classic ECG pattern: LBBB morphology…
Hypokalemia Emergencies
Key Points: Severe hypokalemia can produce dramatic ECG changes that may be mistaken for acute coronary syndromes. It can also precipitate life-threatening arrhythmias, including torsades de pointes and ventricular tachyarrhythmias…
Fascicular Ventricular Tachycardia (Idiopathic Left Fascicular VT)
Key Points Idiopathic reentrant VT arising within the left Purkinje system, most often the left posterior fascicle. Patients are usually young and lack structural heart disease. Signature ECG: RBBB-like morphology…
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