Daily EKG

ECG for acute pericarditis can be confusing. The important point is that it's diagnosed by two points criteria. No. 1 is to identify diffuse ST elevations in all leads irrespective of origin. This will indicate that myocardium as a whole is involved which is especially the case in conditions like myopericarditis. The second part is to identify PR depressions which indicates subepicardial involvement. Take a look at the ECG below to understand the concept. Watch closely for subtle changes in ST and PR segments.

The following EKG showcases a unique situation of old infarction that led to left bundle branch block (LBBB) and fulfills Cornell criteria for left ventricular hypertrophy (LVH). It's a complete package that will help you diagnose all three things from just EKG. The Cabrera’s sign is a good pathognomic of old infaction in the presence of LBBB. Use it to learn yourself and teach your medical students.

The important landmark points to look for in ECG of infero-posterior STEMI incude: ST elevation in inferior leads which are II, III and aVF, reciprocal ST depressions in precordial leads V1-V3 and finally if the lateral wall is involved as well we see changes in I and aVL. The following ECG gets confusion as there are premature ventricular beats which are alternating with normal sinus beats thus making a bigemini pattern.

The limb lead reversal is a very common mistake that happens during the process. It's vital to identify limb lead reversal and differentiate it from other pathological causes of right axis deviation such as dextrocardia. We have summarized the main points of identifying limb lead reversal in the following ECG.

The congenital long QT syndrome puts the patient at high risk for Torsades de Pointes. In this EKG, I have discussed the important morphologic features of T wave in long QT syndrome. The T waves can be associated with U waves which could be either embedded in to the T wave or gets separated. Notice the >0.6 s QT interval in this ECG. This patients is at very high risk for Torsades de Pointes.

Multifocal atrial rhythm is a unique entity that occurs when the natural pacemaker of the heart variably shifts from SA node to atrial to AV node. This generates irregular heart rhythm along with different morphologies of P waves. It is different from multifocal atrial tachycardia in the sense that heart rate is <100 BPM. MAT has same features but the only difference is greater heart rate.