PPCI — which of these ECGs would you call for?
It's a typical ED shift. A nursing colleague passes you an ECG. The presenting complaint is chest pain. Of a set of borderline-looking strips, which would you activate PPCI for?
Session syllabus for this topic: what the literature currently says about UK vs. US STEMI criteria (a young man with 2mm of ST elevation in V2+V3 can trigger the cath lab in the UK, but not in the US); the flaws in current STEMI definitions; the non-ECG factors that influence a PPCI consultant's decision when you call them; and what's actually going through their mind on that call.
VT, or not VT?
No arrhythmia workshop is complete without this question. The session works through VT vs. SVT-with-aberrancy from first principles (the pathophysiology and the literature behind the diagnostic tools available, and their caveats), so the reader can make an informed call rather than defaulting to a rule of thumb.
Bundle branch blocks
Mnemonics like "William" and "Marrow" (for identifying LBBB and RBBB by QRS shape in V1/V6) are crutches that substitute for actually understanding the underlying physiology. Once you understand which bundle branch is blocked, and therefore which ventricle depolarises late and from where, the QRS morphology follows from that, rather than needing to be memorised as a shape to pattern-match.
See Part 8 — The Q wave for the septal depolarisation physiology this builds on.
