ECG Cases Archives - Emergency Medicine Cases

ECG cases is a monthly blog by Jesse McLaren (@ECGcases), a Toronto emergency physician with an interest in emergency cardiology quality improvement and education. Each post features a number of ECGs related to a particular theme or diagnosis (with a focus on acute coronary occlusion), so you can test your interpretation skills. We challenge you with missed or delayed diagnosis, those with false positive diagnosis, and those that had a rapid and correct diagnosis. Cases are followed by a quick summary of the literature that relates to the cases, and we bring it home with practice changing pearls that you can use on your next shift.

ECG Cases 51 – Artifact and Lead Misplacement

ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren... Help Support EM Cases by Giving a Donation here: https://emergencymedicinecases.com/donation/

By Jesse McLaren|2024-09-07T12:12:52-04:00August 19th, 2024|Categories: Cardiology, ECG Cases, EM Cases|Tags: Dr. Jesse McLaren, ECG, ECG artifact, ECG interpretation, lead misplacement|0 Comments

ECG Cases 50 – STEMI: A Failed Paradigm, Enter Occlusion MI

Dr. Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory ischemia, hemodynamic/electrical instability) and POCUS (new regional wall motion abnormalities).

By Jesse McLaren|2024-06-18T12:07:45-04:00June 18th, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: Dr. Jesse McLaren, ECG, ECG interpretation, occlusion MI, STEMI|0 Comments

ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain...

By Jesse McLaren|2024-04-02T12:12:27-04:00April 2nd, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, POCUS Cases|Tags: CHF, ECG, ECG interpretation, occlusion MI, pericardial effusion, POCUS, pulmonary embolism, RV strain, STEMI|0 Comments

ECG Cases 48 – ECG Interpretation in Cardiac Arrest

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occlusion MI/ false negative STEMI...

By Jesse McLaren|2024-02-13T11:44:22-05:00February 13th, 2024|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: cardiac arrest, ECG, ECG interpretation, hyperkalemia, occlusion MI, PE, STEMI, tamponade|0 Comments

ECG Cases 47 – ECG Interpretation in Toxicology

In this ECG Cases Dr. Jesse McLaren delves into ECG interpretation in toxicology and the poisoned patient using his HEARTS approach in 7 case examples. Heart rate/rhythm: consider antidotes for brady/tachy-arrhythmias, and for sinus tachycardia consider fluids for vasodilation and benzodiazepines for agitation. Electrical conduction and axis: consider sodium bicarb for QRS > 100 especially if RBBB or terminal rightward shift, and magnesium for QTc> 500. ST/T changes: consider the differential including demand ischemia, associated electrolyte abnormalities, Brugada pattern from sodium channel blockade, and acute coronary occlusion vs vasospasm from cocaine...

By Jesse McLaren|2023-12-20T16:05:22-05:00December 20th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: alcohol, beta blocker, calcium channel blocker, cocaine, ECG, ECG interpretation, overdose, sodium channel blocker, TCA, toxicology|0 Comments

ECG Cases 46 ECG in Fever and Infectious Disease

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV strain and that fever can unmask Brugada syndrome...

By Jesse McLaren|2023-12-20T15:43:15-05:00October 17th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: atrial fibrillation, Brugada, ECG, ECG interpretation, Fever, Lyme disease, occlusion MI, pericarditis, sepsis, STEMI|2 Comments

ECG Cases 45 ECG in Weakness and Neurological Symptoms

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV thrombus; or cardiac complications like stress-induced cardiomyopathy...

By Jesse McLaren|2023-09-12T14:14:48-04:00September 12th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: ECG, ECG interpretation, neurology, stroke, weak and dizzy|0 Comments

ECG Cases 44 ECG Interpretation in Epigastric pain, Vomiting

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations. We consider electrolyte disturbances and look for ECG signs of hyperkalemia or hypokalemia/hypomagnesemia, and we consider the differential of diffuse ST depression with reciprocal ST elevation in aVR, and false positive STEMI...

By Jesse McLaren|2023-08-08T22:28:20-04:00August 8th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: ECG, ECG interpretation, electrolyte, GI bleed, hyperkalemia, hypokalemia, occlusion MI, pancreatitis, STEMI|2 Comments

ECG Cases 43 – ECG Interpretation in Shortness of Breath

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR. For RV strain, acute vs chronic, we should look for signs of acute RV strain and chronic pulmonary hypertension. for low voltages we should consider pericardial effusion and other causes, and for hyperkalemia we should look for multiple signs of hyperkalemia as a guide for empiric calcium...

By Jesse McLaren|2023-06-06T09:45:16-04:00June 6th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: cardiac tamponade, ECG, ECG interpretation, hyperkalemia, occlusion MI, pericardial effusion, pulmonary embolism, STEMI|0 Comments

ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life...

By Jesse McLaren|2023-05-12T13:36:17-04:00May 10th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: aortic dissection, ECG, ECG interpretation, LVH, occlusion MI, pericarditis, pulmonary embolism, Scarbossa criteria, STEMI|0 Comments

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