Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

12Aug/1119

Littmann’s EKG Course: Miscellaneous

  • 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!
      S1Q3T3 Pulmonary Embolism

      An excellent example of S1Q3T3 in a patient with massive PE. Note the ominous RSR' finding in V1.

      S1Q3T3 no PE

      A similar EKG in a patient with pneumonia, hypoxia, and ARDS... with no PE on CTA.

  • Always check the EKG in a syncopal episode.  Brugada pattern - coved ST segments in V1&V2 - is an indication for ICD placement.

    Brugada Pattern

    This young, healthy patient presented with syncope. He died after being sent home with this EKG. It should have been the indication for an implanted ICD.

9Aug/111

Littmann’s EKG Course: The QRS Complex

  • LBBB makes most EKG's unreadable, except in those where the ST is concordant.  Watch for STEMI!

    LBBB + STEMI

    Inferior STEMI seen in II, III, aVF in a patient with LBBB. ST segments should not be concordant!

  • Electrical alternans can be easy to miss but may indicate an underlying effusion.

    Electrical Alternans

    Electrical Alternans in an HIV patient with an 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.
    Trifascicular block

    RBBB, left posterior fascicular block, and prolonged PR: trifascicular block in a patient with syncope. Emergent indication for pacemaker!