Rhythm Interpretation
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The Syncope ECG With Too Much P
A 68-year-old man has syncope, then has a second syncopal episode while lying still on a stretcher during evaluation at an outpatient clinic. He is sent emergently to the ED….
Preexcitation Pitfalls (Part 3): Wide, Irregular, Fast…Avoid AV Nodal Blockers
A 53-year-old man presents with palpitations and lightheadedness. The following ECG is obtained on arrival and appears very rapid and irregular with changing QRS morphologies. He starts showing signs of…
Preexcitation Pitfalls (Part 2): Wide, Regular, Fast…Treat It Like VT
A young man with recurrent palpitations presents to the emergency department hemodynamically stable during an episode. The arrival ECG shows a wide complex, regular tachycardia and the computer interpretation calls…
Preexcitation Pitfalls (Part 1): The “Inferior STEMI” That Isn’t
A critically ill 38-year-old man presents hypotensive, pale, and diaphoretic with abdominal pain and rectal bleeding. Upright chest X-ray shows free air under the diaphragm, and the patient is headed…
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 2)
A 54-year-old man presents to the emergency department by EMS with acute shortness of breath. A prehospital ECG triggers a STEMI alert based on the computer interpretation. The tracing shows…
Three More ECG Pitfalls That Punish Anchoring Bias
A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally…
The Post-Arrest Wide Complex Rhythm That Was Not VT
A 35-year-old woman arrives at the emergency department after a witnessed seizure and brief cardiac arrest with ROSC. Her arrival ECG shows a very wide complex rhythm that the machine…
Recent ECG Case Highlights from the University of Maryland (Part III)
A 73-year-old man presents to the emergency department with nausea and vomiting. The following ECG was obtained on arrival and interpreted by the computer as “sinus tachycardia”, but something important…
Recent ECG Case Highlights from the University of Maryland (Part II)
A 67-year-old man arrives at the emergency department complaining of lightheadedness. The following ECG is obtained and shows a slow, regular rhythm around 40 beats per minute. The P waves…
Recent ECG Case Highlights from the University of Maryland (Part I)
A 64-year-old man is brought to the ED by EMS just after achieving return of spontaneous circulation following cardiac arrest. He received chest compressions, epinephrine, and was defibrillated prior to…
The Wide Complex Rhythm That Fooled Everyone
A 30-year-old woman presents with one hour of chest discomfort and palpitations. On arrival she is borderline but not frankly unstable. The 12-lead shows a fast rhythm that appears wide…
Not All Wide Complex Tachycardias Are What They Seem
A 40-year-old man presents with chest discomfort and shortness of breath. He’s ashen, diaphoretic, and hypotensive at 90/45. The ECG monitor shows a wide-complex regular tachycardia at 135 bpm concerning…
AFib Overdiagnosis: Dangerous Pitfalls and Safer Reads
A patient presents to the emergency department with new-onset palpitations. He is hemodynamically stable but noted to have an irregular rhythm on arrival. The following ECG is obtained and automatically…
Really Wide, Kind of Slow: VT vs. Toxicity
A 78-year-old woman with PMHx of atrial fibrillation presents to the emergency department with generalized weakness. She is noted to be tachycardic on arrival, is known to be on flecainide…
When to Default to VT and When to Doubt It
A 64-year-old man presents to the emergency department with palpitations. He was recently found to have an acute MI and is one day s/p RCA stenting. The following ECG is…
Regularly Irregular Rhythms: Sorting Mobitz from PACs and Other Causes
A 52-year-old woman presents to the emergency department with weakness. The following ECG is obtained:
Grouped Beats: A Subtle AV Block Pitfall
An elderly patient is brought to the emergency department with acute stroke symptoms and the following routine 12-lead ECG is obtained during the patient’s stroke evaluation:
High-Grade AV Block: New Perspectives and Important Clarifications
A 51-year-old man presents to the emergency department via EMS with nausea, vomiting, weakness, severe bradycardia (HR in the 20s), and hypotension (BP 60s systolic). The following ECG is obtained…
Mobitz I or Mobitz II: How to tell the difference
A 79-year-old man is sent to a community hospital for evaluation of bradycardia discovered at his nursing facility. He is ultimately transferred to a tertiary care facility for consideration of…
Bradycardia, STEMI, and a Misleading Rhythm Diagnosis
A 68-year-old woman calls EMS after having a syncopal episode while using the bathroom. She reports associated chest pain over the past day. The following prehospital ECG is obtained:
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