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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…
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…
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…
Sinus Node Dysfunction (Sick Sinus / Brady-Tachy Syndrome)
Key Points Spectrum, not one rhythm: Look for sinus brady, pauses, arrest, alternating atrial tachyarrhythmias (AF, flutter, ATach). Symptoms matter: Syncope, presyncope, fatigue usually come from cerebral/systemic hypoperfusion, especially after…
Slow Atrial Fibrillation
Key Points Definition: Atrial fibrillation with a slow ventricular response, usually < 60 bpm. ECG: Irregularly irregular rhythm, no discrete P waves, slow R-R intervals. Common causes: AV-nodal blockers (digoxin,…
Aslanger Pattern: OMI Pattern
Key Points: STEMI Diagnosis and Contiguous Leads: While current guidelines typically require ST elevation (STE) in at least two contiguous leads for the diagnosis of STEMI, this practice is not…
Precordial Swirl: OMI Pattern
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…
Polymorphic Ventricular Tachycardia (PMVT)
Key Points Definition: PMVT is a ventricular tachycardia characterized by beat-to-beat variations in QRS morphology, axis, and duration, reflecting multiple ventricular foci or reentrant circuits. Clinical Importance: PMVT is often…
Sodium Channel Blocker Toxicity
Key Points Recognizing the Danger: Sodium channel blocker toxicity can present with a variety of ECG changes that are critical to recognize, especially in patients with altered mental status or…
Nonsustained Ventricular Tachycardia
Key Points Definition: NSVT is defined as ≥3 consecutive ventricular beats, QRS duration >120 ms, rate typically 100-250 bpm (usually > 120 bpm), lasting less than 30 seconds without causing…
EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…
Subtle ST Segment Elevation: OMI Pattern
Key Points: ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…
Brugada Syndrome (BrS)
Key Points: Life-Threatening Sodium Channelopathy: Predisposes to ventricular arrhythmias (VF/VT) and sudden cardiac death (SCD), often in otherwise “healthy” hearts. When to Suspect BrS: Patients with syncope, unexplained “seizures,” ventricular…
Hypokalemic Periodic Paralysis
Key Points Definition: A rare ion channelopathy that causes sudden, reversible episodes of symmetric flaccid paralysis triggered by low serum potassium. It may be inherited or secondary to thyrotoxicosis or…
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