Bifalgorithm post

Have a look at this ECG. At first our eyes go straight to these two, three and AVF, right? And we see really clear signs of ST elevation. And then when we look at these one and AVL, we see reciprocal changes. So this is an inferior STEMI, right? Well, yes, but let's not stop looking. Let's have a look at the P waves and the QRS. So here we see that atrial conduction and ventricular conduction seem entirely unrelated. So we have a second diagnosis. This is also third degree heart block. And why does this happen? Well, there are three reasons. Sudden and severe AV node disease. Like you get with an RCA infarct that supplies the AV node, that's an inferior STEMI. Then you've got sudden and severe failure of conduction of the Hiz-Pekinji system, like you see in an anterior MI that supplies the septum. And the last one is gradual progressive conduction loss of the his/pikinji system, like you get in a true trifocicular block. So what do we do? Well, this is a high risk condition. Think hemodynamic compromise, think stokes/adams attacks, that is intermittent syncope, and potential cardiac arrest through a csterly, V-Tag or V-Fib. They need urgent admission and pacing and then definitive management, a permanent pacemaker and treat that STEMI. This is why it's so important to work through our ECGs with a systematic approach and just because you see one important diagnosis doesn't mean there isn't a second one there as well.

Have a look at this ECG. At first our eyes go straight to these two, three and AVF, right? And we see really clear signs of ST elevation. And then when we look…