Basics & Fundamentals

ECG Basics and Fundamentals: how many STEMI patients present with nondiagnostic initial ECGs?

HPI:  A 52-year-old male with PMHx of HTN & HLD presents to the ED with chest pain and shortness of breath. He looks uncomfortable on exam and is hypertensive. The…

ECG Basics and Fundamentals: does negative troponin ACS still exist?

A 60-year-old male with PMHx of hyperlipidemia presents to the emergency department with midsternal chest pain (tightness), nausea, and diaphoresis. Symptoms have been intermittent, occur with walking and resolve with…

ECG Basics & Fundamentals: Crochetage pattern of QRS notching in the inferior leads

HPI: A 27-year-old woman was having a routine physical exam performed, when her physician noted a systolic murmur at the left upper sternal border. The following ECG is obtained: Case…

ECG Basics & Fundamentals: ECG signs of acute right strain

ECG Basics & Fundamentals: can young patients have an MI?

HPI: 24-year-old male presents to the ED with chest pain. He has no known cardiac risk factors. Pain is constant for the past hour and he is noted to be…

ECG Basics & Fundamentals: how frequently should you obtain serial ECGs in patients with concern for ACS

HPI: A 65-year-old patient is brought in by EMS for a chest pain history that is concerning for ACS. The following ECG is obtained: Case ECG Before watching this week’s…

ECG Basics & Fundamentals: serial ECGs in a patient with chest pain and a paced rhythm

HPI: A 63-year-old male calls EMS after a syncopal episode. He is found to be alert, but complaining of chest pain that radiates bilaterally and that is associated with diaphoresis….

ECG Basics and Fundamentals: ECG findings in hypothermia

HPI: An elderly woman is found down by EMS early in the morning in Baltimore. Her family reports that was drinking some eggnog the night before at a holiday party….

ECG Basics and Fundamentals: Hypertrophic Cardiomyopathy

A 30-year-old female is brought to the ED after a syncopal episode. Her history and physical exam are unremarkable. The following ECG is obtained:

ECG Basics & Fundamentals: reliability of computer interpreted ECGs, can the ECG machine be trusted to get it right?

A 59-year-old man with PMHx of severe hypertension presents to the ED with sharp and positional chest wall pain after a mechanical fall. He denies exertional worsening of pain, or…

ECG Basics & Fundamentals: electrical alternans is present in less than 1/3 of patients with proven cardiac tamponade

A 56-year-old woman with history of breast cancer presents to the ED with chest pain and dyspnea. She is found to be afebrile, tachypneic, and tachycardic with a normal blood…

ECG Basics & Fundamentals: pseudo ST segment elevation in patients with bundle branch blocks

A 75-year-old man presents with a history that is concerning for ischemic chest pain. The following ECG is obtained:

ECG Basics & Fundamentals: the ECG must always be interpreted in the context of clinical presentation

A 20-year- old woman presents to the ED with a history of panic disorder complaining of anxiety and palpitations. The following ECG is obtained:

ECG Basics and Fundamentals: must knows in patients with ST segment elevation in aVR

An 80-year-old man is brought to the ED by EMS for chest pain and dyspnea. He is found to be tachypneic, tachycardic, hypoxic, with a blood pressure of 105/50. The…

ECG Basics & Fundamentals: when to get posterior leads

A 70-year-old man presents to the ED with ischemic chest pain. The following ECG is obtained:

ECG Basics & Fundamentals: chest pain in young patient with no known cardiac risk factors

A 35-year-old man with no PMHx presents to the ED with dull burning chest pain that radiates to his left arm. The following ECG is obtained:

ECG Basics & Fundamentals: when a T wave inversion in lead aVL matters

A 45-year-old woman presents to the ED with severe heartburn. Her pain is associated with dyspnea and diaphoresis. The following ECG is obtained:

ECG Basics & Fundamentals: electrical cardioversion of an unstable regular wide complex tachycardia

A 50-year-old man is brought to the ED with a regular wide complex tachycardia (RWCT) shown below. He is pain free with a normal blood pressure and mental status. His…

ECG Basics & Fundamentals: A systematic approach to EGC interpretation and using differentials for ST segment elevation

A 61-year-old man presents to the ED with malaise, nausea and lightheadedness. The following ECG is obtained:

ECG Basics & Fundamentals: when does the QRS complex end and the ST segment begin in RBBB

A 67-year-old woman with PMHx of Diabetes is brought in by ambulance for 2 hours of chest pain. At arrival she reports mild associated arm pain. The following ECG is…