@ECGWeekly

Our goal is to make ECG interpretation simple, practical, and fun for acute providers; and we believe that mastery of this simple skill will save lives.

ecgweekly.com
Joined September 2017
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458Media
62M with chest pain. The computer sees ST depression and suggests ischemia—but another clue is hiding in the tracing: the check mark, or BAM, sign. What is this ECG warning you about? ecgweekly.com/weekly-workout… ecgweekly.com/weekly-workout…
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MYTH VS. REALITY? 🤔 Sgarbossa and modified Sgarbossa are accepted in the 2022 ACC/AHA chest pain guidelines.
24%Myth
76%Reality
34 votes • Final results
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✅ REALITY. Sgarbossa and modified Sgarbossa are both accepted in the 2022 ACC/AHA chest pain guidelines—and they’re the most widely used in North America.🔎
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A 36-year-old man, previously healthy and physically fit, develops sudden severe chest pain while getting into bed. Paramedics find him awake, flushed, diaphoretic, and clutching his chest. The following 12-lead ECG is obtained.....ecgweekly.com/weekly-workout…
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T-wave alternans: bigger, smaller, bigger, smaller. 🔎 Upright or inverted doesn’t matter—it’s the beat-to-beat change in size. Spot it, and you’ve spotted a patient at very high risk of torsades.
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Electrical alternans: the QRS changes size beat to beat. 🫀 In T-wave alternans, what changes from one beat to the next?
81%The T-wave size
19%The QRS axis
0%The PR interval
0%The heart rate
16 votes • Final results
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📷 The T-wave size. Bigger, smaller, bigger, smaller, beat to beat. Upright or inverted doesn’t matter. It’s different from electrical alternans, and it flags a patient at very high risk of torsades. 📷
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Don’t rely on a long QT to predict torsades. ⚠️ The QT is often prolonged, but T-wave alternans is a far stronger predictor. Long QT: fix the electrolytes and watch closely. T-wave alternans: torsades may be minutes away.
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T-wave alternans can be an ominous warning: bigger, smaller, bigger, smaller from beat to beat. ⚠️ Dr. Mattu explains why this pattern deserves serious attention when you’re worried about impending torsades. Would you recognize it in time? ecgweekly.com/weekly-workout…
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TRUE OR FALSE? 🤔 The Aslanger pattern is part of the formal ACC/AHA STEMI guidelines.
28%TRUE
72%FALSE
36 votes • Final results
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The Aslanger pattern isn’t in the formal ACC/AHA guidelines. It’s been described in the interventional cardiology literature. Dr. Mattu’s tip: if you’re worried, share that literature with your cardiologist so they know what you’re talking about. 🔎
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A 45 yo m presents to the emergency department with palpitations. He has no known history of coronary artery disease. He is alert, with a systolic blood pressure of approximately 120 mm Hg and a heart rate near 180 beats/min. The following ECG shows.......ecgweekly.com/weekly-workout…
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ST elevation in lead III. None in II or aVF. 🫀 The computer reads it as nonspecific. Why might it miss this?
73%Needs 2 contiguous leads
3%Lead III is unreliable
3%The rate is too fast
22%ST change is too small
37 votes • Final results
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✅ It’s looking for ST elevation in two contiguous leads. Lead III alone won’t meet that rule. But isolated ST elevation in III can be part of the Aslanger pattern, linked to acute coronary occlusion. Don’t let “nonspecific” end the read. 🔎
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Don’t dismiss isolated ST elevation in lead III. ⚠️ Your computer is looking for two contiguous leads—so check V1 vs V2 and the lateral leads yourself. It may be the Aslanger pattern: acute RCA or circumflex occlusion without traditional STEMI criteria.
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Chest pain. ST elevation in lead III only. ST in V1 higher than V2. Lateral ST depression with upright T waves. 🔎 Computer: nonspecific. Nonspecific—or acute occlusion?
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71M with chest pain. Lead III has ST elevation—but II and aVF don’t. 👀 The computer called it nonspecific. Cardiology: not a STEMI. But the ED physician recognized a subtle high-risk pattern. What did he see? ecgweekly.com/weekly-workout…
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MYTH OR REALITY? 👀 Any irregular rhythm without obvious P waves is atrial fibrillation.
61%MYTH
39%REALITY
41 votes • Final results
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MYTH ❌Before calling AFib, confirm: No clear P waves marching through The rhythm is irregularly irregular Don’t let “irregular” end the interpretation.
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A 76-year-old man presents with chest pain suggestive of acute coronary syndrome. An initial 12-lead ECG is obtained and shown below, but does not meet conventional STEMI criteria......ecgweekly.com/weekly-workout…
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Grouped beats ≠ automatically AFib. 🔎 Map the P waves: Regular → Mobitz Premature → PACs The rhythm may be hiding in the atria.
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