CREIGHTON/MARICOPA EMERGENCY MEDICINE RESIDENCY
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Ain't right- or- how to read a grossly abnormal appearing ECG

7/30/2016

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Dr. Mattu walks us through how to read an abnormal appear ECG and not miss the subtle MI.  He recommends a logical, stepwise approach.  By considering the differential of each abnormality seen you can begin to understand what is happening with the pt's heart.  Finally, apply the filter of your final diagnosis and look for the subtle clues to ischemia.

1) Rate and Rhythm
2) Axis
3) Intervals
4) Enlargement
5) Ischemia

Some differentials worth reviewing noted below.

Copa Cardiogram #54
Leftward Axis
  • LBBB​
  • Pacer
  • WPW
  • Inferior MI (from Qs)
  • LAFB
  • LVH
  • HyperK
Left Anterior Fascicular Block
  • Axis: LAD
  • I&avL: qR (small q, large R wave)
  • III: rS (small r, large S waves)
Wide QRS
  • BBB
  • Pacer
  • WPW
  • Ventricular ectopy (PVC)
  • Metabolic (acidosis, hyperkalemia)
  • NaCB
  • Non specific intraventricular conduction block (LVH)
Key definition: LAFB + RBBB = Bifascicular block
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    Our thanks to Dr. Tim Davie for assembling the Copa Cardiogram each week.  Please follow this link to get to spreadsheet of all Copa Cardiograms.

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Department of Emergency Medicine
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  • Home
  • Program
    • Program Director's Message
    • Benefits
    • Clinical Sites >
      • Valleywise Health
      • Arizona Burn Center
      • Phoenix Children's Hospital
      • Banner University Medical Center – Phoenix
      • Toxicology - BUMCP
      • Mayo Clinic Arizona
      • Banner Cardon Children's Medical Center
    • Curriculum >
      • Curriculum
      • Electives
    • Diversity + Inclusion
    • Faculty >
      • Department Chair
      • Faculty Bios
      • Faculty Alumni
      • Program Coordinators
    • Residents >
      • Class of 2021
      • Class of 2022
      • Class of 2023
      • Alumni
    • Students >
      • Adult EM Rotation
      • Ultrasound Rotation
      • Applying to Rotate
      • Applying to the Program
      • Interviews
    • Research
    • Vision & Principles
    • Ultrasound >
      • Ultrasound Director
      • Ultrasound Fellowship
      • Education (internal link)
      • Admin (internal link)
    • Admin Fellowship