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Teaching assets

Synthetic cases for practice

Waveforms and laboratory panels are generated from structured numbers. Nothing here is physician-reviewed.

Evolving chest-pain case

Nine original teaching strips. Each one is drawn from a pattern definition, not from a picture. The shaded band marks the feature named on the tracing.

ST-segment elevation

ST-segment elevationSinus beats with a P wave, a narrow QRS, then a flat ST segment held above the baseline before an upright T wave.Flat ST shelf

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
After the QRS, the ST segment is lifted off the baseline and stays up.
Think
Flat elevation in a coronary territory is an emergency reperfusion pattern until that is excluded.
Do not confuse with
A scooped ST that rises into the T, especially with PR depression, which is the pericarditis pattern.

ST-segment depression

ST-segment depressionSinus beats with the ST segment pressed below the baseline, flat, then an upright T wave.ST below baseline

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
The ST segment is below the baseline, flat or sloping down, not part of the QRS.
Think
Ischemia, strain, or a reciprocal change. Read it with the other leads and the story.
Do not confuse with
The normal slope where the QRS returns to the baseline. True depression stays down after the J point.

T-wave inversion

T-wave inversionSinus beats with a narrow QRS and a deep T wave pointing down, opposite an upright QRS.Inverted T

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
The T wave turns over. The QRS itself is still upright.
Think
Ischemia, strain, or a memory T after pacing or a fast rhythm. New and deep matters more.
Do not confuse with
A wide negative QRS. Here the downward wave is the T, after a narrow QRS.

Delta wave

Delta waveShort PR interval, then a slurred slow upstroke into the R wave, so the QRS starts early and is wider.Slurred onset

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
The PR is short and the QRS begins with a slur instead of a sharp deflection.
Think
Ventricular pre-excitation. An extra pathway is activating the ventricle early.
Do not confuse with
Bundle-branch block, which widens the QRS but does not slur the onset after a short PR.

J wave

J waveA narrow QRS with a positive notch right where the QRS meets the ST segment, then a return toward the baseline.Notch at the J point

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
A hump sits at the J point, between the QRS and the ST segment.
Think
The classic setting is hypothermia. Some early-repolarization patterns have a notch too. The story decides the urgency.
Do not confuse with
An ST shelf that stays elevated. A J wave is a notch, and the ST segment after it is not a long plateau.

Pericarditis pattern

Pericarditis patternPR segment dipped below the baseline, then an ST segment that curves upward into the T wave rather than forming a flat shelf.PR dip and scooped ST

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
PR depression and an ST segment that scoops up into the T.
Think
Widespread concave elevation with PR depression is the teaching picture of acute pericarditis.
Do not confuse with
A flat ST shelf in one territory. That pattern is not treated with a lytic drug.

Torsades de pointes

Torsades de pointesA fast wide rhythm whose peaks grow and shrink and flip from one side of the baseline to the other.Twisting points

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
The points twist around the baseline. Amplitude and direction change from beat to beat.
Think
Polymorphic ventricular tachycardia. Look at the QT on a beat from before the run, and at potassium and magnesium.
Do not confuse with
Monomorphic ventricular tachycardia, where every wide beat has the same shape.

Wide-complex tachycardia

Wide-complex tachycardiaA regular run of wide QRS complexes, each the same shape, with no P wave in front of them.Same wide beat, regular

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
Wide beats, evenly spaced, and each beat looks like the one before it.
Think
When a regular wide-complex tachycardia is uncertain, treat it as ventricular tachycardia.
Do not confuse with
Torsades, which changes height and direction instead of repeating one shape.

Atrial fibrillation

Atrial fibrillationNo discrete P waves, a low wavering baseline, and narrow QRS complexes separated by unequal intervals.Uneven R-R gaps

Original synthetic tracing for teaching. Not a patient recording and not physician-reviewed.

Recognize
No single P wave, a wavy baseline, and R-to-R gaps that keep changing.
Think
Atrial fibrillation. The irregular spacing is part of the finding, not a separate rhythm.
Do not confuse with
A regular rhythm that simply has no visible P wave, such as a junctional rhythm.