- S1Q3T3 is a pattern of acute right heart strain and is not specific to pulmonary embolism. It may be seen with severe pneumonia, ARDS, tension pneumothorax, or pulmonary hemorrhage.
- Watch for RSR' in V1, this is a very ominous finding!
- Always check the EKG in a syncopal episode. Brugada pattern - coved ST segments in V1&V2 - is an indication for ICD placement.
- 1-3mm upsloping ST depressions in V1-V6 with tall, symmetric T-waves is highly concerning for hyperacute proximal LAD STEMI.
- N Engl J Med 2008;359:2071-3 Heart 2009;95:1701-6
- The T-waves in hyperkalemia are often simply narrow-based rather than tall. Because of this, the computer software often "double counts" the heart rate.
- When faced with a QRS with a terminal "notch" and hammock shaped ST's:
- Consider pericarditis if tachycardic.
- Consider benign early repolarization if normal rate.
- Consider hypothermia if bradycardic.
- The "aVR sign." Chest pain, ST elevation in aVR and diffuse ST depressions is 80% sensitive for LAD main and high mortality.
- LBBB makes most EKG's unreadable, except in those where the ST is concordant. Watch for STEMI!
- Electrical alternans can be easy to miss but may indicate an underlying effusion.
- The finding of marked axis deviation, RBBB, and prolonged PR interval is concerning for trifascicular block. In a patient with unexplained syncope this is a potentially lethal finding; admit for emergent pacemaker.
- P-wave inversions in lead I are never normal. Consider 3 common etiologies:
- Ectopic atrial rhythm - V1-V6 also reveal inverted P's from an abnormal depolarization site.
- Dextrocardia - V1-V6 show r-wave regression.
- Limb lead reversal - lead II shows a "flat line", repeat the EKG with a better tech.
- "Sinus tachycardia with 1° AV block"
- "Sinus tachycardia with short PR"
- * cannot find p-wave axis