LAS VEGAS—Anders Osthus, DO, is going to need a few days to process all of the clinical pearls on Q waves, atrioventricular (AV) dissociation, and acute and chronic cor pulmonale presented in a rapid-fire session titled “Mastering Three Problems that can Kill in Emergency Electrocardiography: An Advanced Approach.”

He’s not the only one, either. The session proved so popular that a line snaked down a hallway of Mandalay Bay and pushed the start time back.

“That was really high-level, expert EKG interpretation,” said Dr. Osthus, an emergency physician at Essentia Health in Duluth, Minn. “I look at, I don’t know, 10 to 20 EKGs a shift? Those [pearls] will obviously pop into my mind at some point…the little individual things may bring up something you haven’t thought of when you’re looking at your next EKG.”

And that’s exactly the kind of reaction session presenter Jerry Jones, MD, FACEP, founder of Houston-based Medicus, wanted to hear. Dr. Jones has said he chose to focus on the three issues because they tend to be difficult for many emergency physicians to interpret.

“You can see changes there that confuse them, that sometimes worry them and they’re not sure what they mean,” he said.

For example, Dr. Jones, has noted that abnormalities in Lead III results—be they Q waves or negative complexes—are not necessarily difficult to find, but that’s only if people are looking for the nuances they can present.

“In electrocardiography, when we’re concerned whether or not a patient is having an acute myocardial infarction, of course we’re more concerned with repolarization changes, ST segment changes, Q wave changes,” Dr. Jones added. “But we should also still be concerned about the presence of Q waves already on the ECG.”

When it comes to third-degree AV block, Dr. Jones found himself repeating himself to drive home his points, which included a reminder that AV dissociation is like a cough. It’s not a diagnosis. It’s an electrocardiographic symptom. And, third-degree AV block “is a very infrequent cause.”

“You cannot diagnose third-degree AV block based on AV dissociation alone. That is the most important thing to get out of this session,” he said. “Now I want to move on to the second most important thing. You cannot diagnose third-degree AV block based on AV dissociation alone…there are too many other reasons for AV dissociation.”