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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 30 Beware Computer Interpretation Errors

Computer interpretation of the ECG has been called a double-edged sword: when correct, it increases physician accuracy, but when incorrect it increases errors. This is especially problematic in the emergency department, where computer accuracy drops as clinical significance increases—with common errors for arrhythmias and ischemia. Jesse McLaren guides us through 10 cases where the computer interpretation misguides us and how to avoid these pitfalls...

ECG Cases 29 Misdiagnosis from Lead Misplacement, Artifact and Lead Reversal

In this ECG Cases blog we review 10 cases of possible artifact, lead reversal and lead misplacement. Can you spot the abnormalities and avoid the misdiagnosis?...

ECG Cases 28 Approach to Atrial Fibrillation

Jesse McLaren explains his AFIB mnemonic for approach to atrial fibrillation that involves 4 questions: 1. Is it atrial fibrillation? 2. If it is atrial fibrillation and there is rapid ventricular response, is it fast from a secondary cause? 3. If it is atrial fibrillation with a rapid ventricular response without a secondary cause, what is the intervention? 4. Does the patient need an anticoagulant started in the ED? and runs through 10 cases to elucidate the nuances of atrial fibrillation management on this ECG Cases blog...

By |2022-02-28T10:29:20-05:00February 28th, 2022|Categories: ECG Cases|Tags: , , |0 Comments

ECG Cases 27 Pericarditis – Diagnosis of Exclusion

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude more serious causes of chest pain, eg wraparound LAD occlusion, inferior OMI 2. Exclude complications of pericarditis, eg myocarditis, large pericardial effusion 3. Exclude normal variant ST elevation presenting with benign chest pain on this month's ECG Cases blog...

ECG Cases 26: Pulmonary Embolism and Acute RV Strain

In this month's ECG Cases Dr. Jesse McLaren runs through 10 cases and explains how the ECG can be integral in the diagnosis and management of pulmonary embolism, even though it is not incorporated into any of the commonly used decision tools for diagnosis of pulmonary embolism...

ECG Cases 25: ‘Late STEMI’ – How acute is the coronary occlusion?

In this ECG Cases blog we look at 10 patients with potentially ischemic symptoms. Which had a coronary occlusion, and how acute were they? Jesse McLaren explains 'Late STEMI' and how reperfusion strategies should not be based on time of symptom onset...

ECG Cases 24 Reciprocal Change and Occlusion MI

Dr. Jesse MacLaren reviews 10 ECG cases highlighting how reciprocal change can be secondary to LBBB/LVH, primary changes, or both, how it can be the first and remain the dominant sign of occlusion, pointing to subtle ST elevation or hyperacute T waves, how it can can highlight subtle inferior, lateral or proximal LAD occlusions, how it can be the only sign of posterior OMI; and how it can be absent in mid-distal LAD occlusion...

ECG Cases 23 – Wellens syndrome, reperfusion and reocclusion MI

Eight patients presented with potentially ischemic symptoms and T-wave inversions. Which had occlusion MI, which were reperfused and which were reoccluded? Jesse McLaren helps you discover the nuances of Wellens syndrome and T-wave inversions on this month's ECG Cases blog...

By |2021-07-13T12:27:47-04:00July 13th, 2021|Categories: Cardiology, ECG Cases, Emergency Medicine, Medical Specialty|Tags: , , , |0 Comments

ECG Cases 22: T-wave INVERSION mnemonic

The differential for T-wave INVERSION includes: Incorrect lead placement, No bundle (RBBB, LBBB), Ventricular hypertrophy (LVH, RVH), Embolism, Reciprocal/refractory/reperfused occlusion MI, Sudden death (ARVD), Iatrogenic (digoxin), Obtunded (eg SAH), and Normal variant. Jesse McLaren runs through 10 cases of patients who present to the ED who have T-wave inversions on their ECGs...

ECG Cases 21: Hyperacute T-waves and Occlusion MI

In this month's ECG Cases blog, Dr. Jesse MacLaren guides us through 10 cases of patients whose ECGs show tall T-waves and gives us the tools to distinguish the hyperacute T-waves of occlusion MI from other causes of tall T-waves....

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