Ecgstasy!

If you haven’t checked out LITFL’s ECG Library recently, I suggest you get on over and have a look around… It is turning into something truly awesome!

There is still the odd nut or bolt missing, but whether you’re after the ECG Basics, an A-Z collection of ECG diagnoses, or trying to visualise how to localise a myocardial infarction you’ll find something marvelous. And we haven’t even mentioned the eponymous syndromes or the ‘test yourself’ clinical cases yet!

Dr Ed Burns has been slaving away on this project for some time now, largely behind the scenes, and the ECG Library’s escalating awesomeness is in large part down to him. We’ve also been fortunate to welcome aboard another ECG geek in Dr John Larkin, so you can expect exponential elevations in ecgstasy on LITFL from now on!

Another great addition to the library is the ECG Academy page collecting together Dr Nick Tullo’s brilliant videos. Ever wanted private tuition from a cardiac electrophysiologist? Well, now you can… Here’s a taster of one his great ‘chalktalk’ sessions:

Meanwhile the LITFL team is going to ever increasing extremes to ensure that the future of the ECG Library is in good hands— we’ve got prospective contributors reading ECGs within a day of being born!

ECG Clinical Interpretation: A to Z by diagnosis

A

• Accelerated idioventricular rhythm
• Accelerated junctional rhythm
• Anterior STEMI
• Arrhythmogenic right ventricular dysplasia
• Atrial flutter
• Atrial fibrillation
• Atrial ectopic beat / atrial premature beat
• Atrial tachycardia
• Automatic junctional tachycardia
• AV block: 1st degree
• AV block: 2nd degree, Mobitz I (Wenckebach)
• AV block: 2nd degree, Mobitz II
• AV block: 2nd degree, “fixed ratio blocks” (2:1, 3:1)
• AV block: 2nd degree, “high grade AV block”
• AV block: 3rd degree (complete heart block)
• AVNRT (AV-nodal re-entry tachycardia)
• AVRT (atrioventricular re-entry tachycardia)

B

• Benign early repolarisation
• Beta-blocker toxicity
• Bidirectional ventricular tachycardia
• Bifascicular block
• Biventricular enlargement
• Biatrial enlargement
• Brugada syndrome

C

• Calcium-channel blocker toxicity
• Carbamazepine cardiotoxicity
• Cardiomyopathy, dilated
• Cardiomyopathy, hypertrophic
• Cardiomyopathy, restrictive
• Chronic obstructive pulmonary disease (COPD)

D

• Dextrocardia
• Digoxin effect
• Digoxin toxicity
• Dilated cardiomyopathy

E

• Ectopic atrial tachycardia
• Electrical alternans
• Emphysema
• Escape rhythms, junctional
• Escape rhythms, ventricular

F

• Fascicular VT
• Fusion beats

H

• High take-off
• Hypercalcaemia
• Hyperkalaemia
• Hyperthyroidism
• Hypertrophic cardiomyopathy (HCM)
• Hypocalcaemia
• Hypokalaemia
• Hypomagnesaemia
• Hypothermia
• Hypothyroidism

I

• Interventricular Conduction Delay (QRS widening)
• Intracranial haemorrhage
• Intrinsicoid deflection

J

• J-point elevation
• Junctional ectopic beat / junctional premature beat
• Junctional escape rhythm
• Junctional tachycardia

L

• Lateral STEMI
• Lead reversals: Limb Lead Reversals (overview)
• Lead reversal: Left arm/right arm
• Left atrial enlargement
• Left anterior fascicular block
• Left axis deviation
• Left bundle branch block
• Left bundle branch block — diagnosing myocardial infarction (Sgarbossa criteria)
• Left main coronary artery occlusion (ST elevation in aVR)
• Left posterior fascicular block
• Left ventricular aneurysm
• Left ventricular hypertrophy
• Lown-Ganong-Levine syndrome
• Low QRS Voltage

M

• Movement artefact
• Multifocal atrial tachycardia
• Myocardial ischemia
• Myocarditis

N

• Non-paroxysmal junctional tachycardia

P

• Pacemaker rhythms: Normal pacemaker function
• Pacemaker malfunctions: Failure of capture, pacemaker-mediated tachycardia, etc.
• Paroxysmal atrial tachycardia (PAT)
• Paediatric ECG
• Pericardial effusion / tamponade
• Pericarditis
• Persistent ST elevation (LV aneurysm morphology)
• Polymorphic ventricular tachycardia
• Poor R wave progression (PRWP)
• Posterior STEMI
• Preexcitation
• Premature complexes, atrial
• Premature complexes, junctional
• Premature complexes, ventricular
• Pulmonary disease, chronic
• Pulmonary embolism

Q

• QRS widening
• Quetiapine toxicity

R

• Raised intracranial pressure
• Restrictive cardiomyopathy (myocardial infiltrative disease)
• Right atrial enlargement
• Right axis deviation
• Right bundle branch block
• Right ventricular hypertrophy
• Right ventricular MI
• Right ventricular outflow tract (RVOT) tachycardia
• Right ventricular strain
• R-wave peak time

S

• Sgarbossa criteria (diagnosing AMI in LBBB)
• Shivering artefact
• Short QT syndrome
• Sinus rhythm
• Sinus arrhythmia
• Sinus bradycardia
• Sinus node dysfunction (Sick sinus syndrome)
• Sinus node exit block
• Sinus node reentrant tachycardia
• Sinus pause / arrest
• Sinus tachycardia
• Sodium channel blocker overdose
• ST elevation in aVR (LMCA/3VD)
• STEMI, anterior
• STEMI, high lateral
• STEMI, inferior
• STEMI, lateral
• STEMI (old)
• STEMI, posterior
• STEMI, right ventricular
• Subarachnoid haemorrhage
• Supraventricular tachycardia (SVT)

T

• Tako Tsubo Cardiomyopathy
• Torsades de Pointes
• Tremor artifact
• Tricyclic overdose (sodium-channel blocker toxicity)
• Triple vessel disease
• Trifascicular block

V

• Ventricular aneurysm
• Ventricular escape rhythm
• Ventricular fibrillation
• Ventricular flutter
• Ventricular ectopics / ventricular premature beats
• Ventricular tachycardia: Fascicular VT
• Ventricular tachycardia: Monomorphic VT
• Ventricular tachycardia: Overview of VT
• Ventricular tachycardia: Right Ventricular Outflow Tract (RVOT) tachyardia
• VT versus SVT with aberrancy

W

• Wellens Syndrome
• Wolff-Parkinson White Syndrome

References

• ECG CLINICAL CASES — Your favourite ECG’s placed in clinical context with a challenging Q&A approach
• ECG IMAGE Database — Searchable database of LITFL ECG’s
• ECG and Cardiology Eponymous Syndromes — Cheats guide to eponymous emancipation
• The Art of infarct localisation
• ECG Exam Template — a framework for the FACEM part 2 exam.
• ECG Reference Sites on the WEB — the best of the rest