ECG DIFFERENTIALS Flashcards
30 Second Approach to ECG’S by EM RAP
RATE:
Tachydysrhythmia
Bradydysrhythmia
If Rate okay…
MOST PROMINENT FEATURE:
Wide QRS
Prolonged QT
STE
STD
Big Ts
Flipped T’s
SINUS RHYTHM
Rate 60 - 100
P-Wave axis +15 to +75
Upright P waves in leads I, II, III, and aVF
Inverted T waves in leads aVR and V1
TACHYDYSRHYTHMIAS
NARROW REGULAR
Sinus Tachycardia
Orthodromic WPW
SVT (AVNRT)
Atrial Flutter 2:1
NARROW IRREGULAR
Multifocal Atrial Tachycardia
Afib
Atrial Flutter with Variable Block
WIDE REGULAR
Antidromic WPW
Monomorphic VT
SVT with Abberancy
Consider hyperkalemia, acidosis, Na channel blockade
QRS > 140 ms is more likely VT
In the abscence of underlying medical causes, assume VT unless proven otherwise
WIDE IRREGULAR OR POLYMORPHIC COMPLEX (BEAT TO BEAT VARIATION IN QRS)
Afib with Aberrancy (MCC)
Polymorphic V Tachor Torsades
WPW with AFib
BRADYDYSRYTHMIAS
CRITICAL CAUSE:
Hyper K+
Ischemia
Drugs
Hypothermia
RHTYHMS
SA Block
AV Block
WIDENING QRS
Hyperkalemia
Hypercalcemia
Sodium Channel Blocker Toxicity
PROLONGED QT
Hypokalemia
ST ELEVATION
4 BAD THINGS
STEMI
Hyperkalemia
Spasms (Prinzmetal Angina)
Brugada
4 STEMI MIMICS
Pericarditis
LVH
LV Aneurysm
BER
ST DEPRESSION
STEMI or NEAR STEMI:
Reciprocal Changes
Posterior MI
deWinter’s
STE aVR
NON-STEMI/ ISCHEMIA:
Non-STEMI
LVH
OTHER:
Digoxin
BIG T WAVES
3 BAD THINGS:
Hyperkalemia
STEMI
deWinter’s
OTHER:
BER
DEEP INVERTED T WAVES
Brugada
SAH
Wellen’s
Arrythmogenic Right Ventricular Dysplasia (ARVD)
MI
Myocarditis / Pericarditis
PE
SYNCOPE
BASIC THINGS:
Arrythmia
Ischemia
EXOTIC THINGS:
Arrythmogenic Right Ventricular Dysplasia (epsilon waves, flipped t waves V1-V3)
Brugada (RBBB, STE, V1-V3)
Left Ventricular Hypertrophy (marked high voltage)
Pulmonary Embolism (Right axis shift, S1Q3T3, RBBB, Deep flipped t waves V1-V3)
QT too long / too short (Qt > 1/2 RR)
Wolf-Parkinson White
