Basics & Fundamentals

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Sloof Lirpa Sign

A 65-year-old woman presents to the emergency department with an episode of near-syncope. Her ECG shown below is interpreted by the ECG machine, an emergency physician, and a cardiologist as…

Interesting Cases from UMMC, Part I

A 63-year-old man presents to the emergency department with acute chest pain and an episode of syncope. The following ECG is obtained, and the cath lab is activated for suspected…

Literature Review: Resolution of ST elevation in STEMI

Paramedics are transporting a middle aged male with chest pain and an obvious inferior STEMI. They arrive to the emergency department and the following ECG is obtained on arrival about…

2024 EM Boards ECG Review Part II

A 55-year-old man with a known left bundle branch block presents to ABEM general hospital with acute chest pain. Vital signs are normal and his pain is slightly improved with…

2024 EM Boards ECG Review Part I

A 61-year-old man with a history of atrial fibrillation presents to ABEM general hospital with lightheadedness and palpitations. He is tachycardic but otherwise has normal vital signs. The following ECG…

Wide Complex Tachycardias: using modified ECG leads to distinguish ventricular tachycardia from supraventricular tachycardias (VT vs. SVT)

A 60-year-old man presents to the emergency department with left sided chest pain and lower extremity edema. Initial vitals: HR= 155, BP = 120/96, RR = 22, SpO2 = 90%,…

Wide Complex Tachycardias: can ECG algorithms safely rule out ventricular tachycardia in the emergency department?

A 45-year-old man with PMHx of hypertension, obesity, and tobacco use presents to the ED with palpitations. Symptoms have been intermittent throughout the day with an associated episode of syncope….

STAT ECG Diagnoses: are ECG abnormalities necessary for the diagnosis of acute pericarditis?

2 separate 50-year-old men present to the emergency department with chest pain. Pain in both patients is described as sharp, pleuritic, and positional. The following ECGs are obtained:

Several ECG cases from UMEM that highlight the importance of pattern recognition and a good history to differentiate between benign vs. life threatening ECG findings!

A 76-year-old woman is brought to the emergency department by EMS with for lightheadedness and syncope. The following ECG is obtained on arrival:

ECG Basics and Fundamentals: causes of pauses or clumped/grouped beats on the ECG

A 72-year-old man with PMHx of HTN presents to the emergency department with vomiting and lightheadedness. He is noted to be slightly bradycardic with an irregular rhythm on arrival. The…

ECG Basics & Fundamentals: the value of clinical decisions instruments and what to do when evaluating patients with a concerning chest pain story

A 68-year-old man with PMHx of HTN and cigarette smoking presents to the ED with severe central chest pain and mild shortness of breath for 1 hour. Pain is constant…

ECG Basics and Fundamentals: the earliest evidence of cardiac ischemia on the ECG and when to obtain serial ECGs

A 68-year-old man is brought into the emergency department for acute chest pain radiating to the back. He appears very uncomfortable and is hypertensive on arrival. A CT angiogram is…

ECG Basics and Fundamentals: T wave inversions and the importance of precordial lead placement

A 32-year-old female with a PMHx of obesity and tobacco use presents to the emergency department with 1 day of sharp midsternal chest pain. Pain is intermittent, non-radiating, and associated…

ECG Basics and Fundamentals: subtle early signs of acute cardiac ischemia

A 57-year-old man presents to the emergency department with chest pain concerning for MI. The following ECG is obtained with no prior ECGs available for comparison. Cardiology is contacted and…

ECG Basics and Fundamentals: PR segment or TP? the isoelectric baseline you should use to measure ST segment deviation

 A 45-year-old woman presents to the ED with severe chest pain. She is minimally cooperative when trying to obtain a history and is requesting pain medication for severe pain. Physical…

ECG Basics & Fundamentals: reliability of computer interpreted “Normal ECG” by the ECG machine

A 64-year-old man with PMHx of HTN and HLD presents to a busy ED with chest pain, shortness of breath, and nausea. There is no immediate bed availability in the…

ECG Basics and Fundamentals: a condition that is commonly misdiagnosed at polymorphic ventricular tachycardia (PMVT), torsades de pointes, and ventricular fibrillation

A 55-year-old woman presents to the ED with mild to moderate COVID pneumonia. She reportedly had a syncopal episode while on a bed pan. The following rhythm strip was obtained…

STAT ECG Diagnoses: the basics of left bundle branch blocks (LBBB) and how to identify occlusion MI in these patients

A 65-year-old man presents to the ED with chest pain and diaphoresis concerning for an acute coronary syndrome. The following ECG is obtained:

ECG Basics and Fundamentals: the value of ignoring the ECG computer interpretation and looking closely at all 12 leads

A 48-year-old female presents to the ED with palpitations and near-syncope. She reports multiple episodes of palpitations in the past that have not been evaluated. The following ECG is obtained:

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