Clinical Pearls from our first ever (and hopefully monthly) ECG Report!

• Make sure to always work through an ECG in a systematic way in order to avoid missing key information.
• Remember that you might not see any p waves (or retrograde P waves) in AVRT and AVNRT.  Both of these rhythms would be fast and regular.  A fib, by contrast, would be irregular.
• Hypercalcemia presents with a shortened QT and a loss of the ST segment on ECG.  But make sure you are ruling out an MI because often times the loss of ST segment resembles a STEMI.
• Whenever you see a downward p wave in lead I, think of two diagnoses:
  • Dextrocardia
  • Limb lead reversal
• Easiest way to distinguish between dextrocardia and limb lead reversal is to look at the QRS amplitude as you move across the precordium.  If the amplitude is decreasing as you advance from V1 to V6, then the diagnosis is dextrocardia because you are moving away from the heart.  If the amplitude is not changing or increasing, then the diagnosis is limb lead reversal.
• The presence of > 2 mm coved precordial ST-segment elevation (leads V₁through V₃) with T wave inversions is suggestive of Brugada morphology.  In a patient with history of syncope, ventricular arrhythmias, or family history of Brugada syndrome, this is consistent with a diagnosis of Brugada syndrome and would require ICD placement.

Have an interesting ECG?  Save them/send them our way for our next ECG report!