- 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.
- 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.