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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…
Beta-Blocker and Calcium Channel Blocker Toxicity
Key Point BBs and CCBs are widely prescribed but overdoses can cause life-threatening bradycardia, AV block, hypotension, and shock. Differentiating between them is important, but both require early recognition, aggressive…
Cocaine Toxicity
Key Point Cocaine is a powerful sympathomimetic with profound cardiovascular (CV) effects. Even recreational or first-time use can precipitate life-threatening complications, including myocardial infarction (MI), stroke, arrhythmias, and aortic dissection….
Slow Ventricular Tachycardia (VT)
Key Points Definition: Slow ventricular tachycardia is defined as a wide complex tachycardia with a ventricular rate between 100–120 bpm. Distinction: Typical sustained VT usually exceeds 120 bpm. When encountering…
R-on-T Phenomenon
Key Points Definition: The R on T phenomenon occurs when an ectopic impulse (often a PVC or cardioversion shock) falls on the T wave of the preceding beat. Mechanism: Interrupting…
Right Ventricular STEMI: Criteria & Pitfalls
Key Points: RV involvement accompanies up to ~40% of inferior STEMIs; isolated RV infarction is uncommon but high-impact when missed. Think RV MI when inferior STEMI is present and you…
Toxicologic Emergencies
Key Points: ECG as a Critical Diagnostic Tool: In toxicology, the ECG is often the first and most reliable clue. Early recognition of drug-induced conduction disturbances or arrhythmias can guide…
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…
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…
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,…
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…
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…
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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