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Non-Thrombotic Causes of Acute MI
Key Points: Primary MI ≠ Always Plaque Rupture: Atherothrombosis from plaque rupture or erosion remains the most common cause of primary MI, but the Fifth Universal Definition of MI now…
Traditional STEMI Criteria
Key Points: STAT ECG Is the First Decision Point in Suspected ACS: The immediate purpose of the initial ECG is to identify acute coronary ischemia, particularly STEMI or another pattern…
Occlusion MI: STEMI & Beyond Hub
Key Points: The ECG’s Primary Role in ACS Is Detecting Acute Coronary Occlusion: Acute coronary occlusion is a time-critical diagnosis in which rapid recognition and reperfusion can preserve myocardium and…
EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points: Get the ECG Early: Obtain and interpret a high-quality 12-lead ECG within 10 minutes of first medical contact (FMC) in patients with suspected ACS. Early prehospital ECG acquisition…
Monomorphic Ventricular Tachycardia (MMVT)
Key Points Definition: Monomorphic ventricular tachycardia is a ventricular rhythm with a wide QRS and a single, uniform QRS morphology throughout the run. Sustained VT: VT is sustained when it…
Syncope & “Seizure” Emergencies
Key Points: ECG Early: Obtain a 12-lead ECG early in patients with unexplained syncope or seizures. Patients with suspected cardiac or arrhythmic syncope should also receive continuous cardiac monitoring. Repeat…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition: Arrhythmogenic cardiomyopathy (ACM), historically called arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D), is an inherited myocardial disease characterized by progressive myocardial injury and fibrous replacement, with or without fatty…
Hypokalemia Emergencies
Key Points: Severe hypokalemia can result in an arrhythmia emergency. The major threat is ventricular tachyarrhythmias, including torsades de pointes, polymorphic ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Severe…
Escape-Capture Bigeminy
Key Points: Definition: Escape-capture bigeminy is an uncommon rhythm in which escape beats alternate with conducted sinus capture beats, producing a repeating paired pattern. Mechanism: Sinus slowing, sinus pauses, or…
Severe Hypothermia
Key Points: Severe hypothermia produces progressive electrical slowing. Sinus bradycardia, PR prolongation, QRS widening, QT prolongation, and atrial fibrillation with a slow ventricular response become increasingly common as core temperature…
Slow Ventricular Tachycardia (VT)
Key Points: Definition: Slow VT refers to ventricular tachycardia occurring at an unusually low ventricular rate, often near or even below the conventional tachycardia threshold. There is no universally accepted…
Ventricular Tachycardia (VT) Mimics
Key Points: Default assumption: A regular wide-complex tachycardia should be considered VT until another diagnosis is more likely. Rate modifies the differential, not the diagnosis. Typical monomorphic VT is often…
Hypertrophic Cardiomyopathy With LVOT Obstruction
Key Points: Definition: Hypertrophic cardiomyopathy (HCM) is characterized by otherwise unexplained LV hypertrophy. In obstructive HCM, septal hypertrophy plus systolic anterior motion (SAM) of the mitral valve produces dynamic left…
Yamaguchi Pattern: Apical Hypertrophic Cardiomyopathy (ApHCM)
Key Points: Definition: Apical hypertrophic cardiomyopathy (ApHCM) is an HCM phenotype in which hypertrophy predominantly involves the LV apex. Signature ECG: High QRS voltage with deep, symmetric T-wave inversion, classically…
ST Depression V1-V4: OMI Pattern
Key Points: Posterior OMI can hide on the standard 12-lead. Acute posterior coronary occlusion may produce no diagnostic ST elevation in the conventional leads. Instead, posterior ST elevation is seen…
S1Q3T3 Pattern
Key Points: Not a PE diagnosis: S1Q3T3 is classically associated with pulmonary embolism, but it is neither sensitive nor specific enough to diagnose or exclude PE. Think acute right heart…
High Risk Pulmonary Embolism (PE)
Key Points: The ECG can provide an early warning of severe RV strain: No ECG finding defines high risk PE, but marked or evolving signs of acute RV pressure overload…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is one of the most common non-ischemic causes of ST elevation and one of the most frequent ECG mimics of acute anterior coronary occlusion. The…
Brugada Syndrome (BrS)
Key Points: What It Is: Brugada syndrome is an inherited arrhythmogenic disorder associated with ventricular fibrillation (VF), polymorphic VT, and sudden cardiac death, often in patients without obvious structural heart…
Barcelona Criteria in Left Bundle Branch Block (LBBB): OMI Pattern
Key Points: The Barcelona Criteria are ECG criteria proposed to identify acute myocardial infarction in patients with LBBB. Core problem: LBBB causes expected secondary ST-T changes, so standard STEMI millimeter…
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