Amal Mattu’s ECG Case of the Week – November 9, 2015

HPI: A 60-year-old male with a history of CAD with a pacemaker presents to the ED with acute chest pain that radiates to the left arm. Pain is worse with exertion, and associated with diaphoresis & vomiting. The following ECG is obtained:

Case ECG

Before watching this week’s video, ask yourself these questions:

  1. Which patients with ischemic chest pain should go to the cath lab emergently?
  2. How useful is the ECG in diagnosing STEMI in patients with pacemakers?
  3. Would you activate the cath lab based on this HPI and ECG?


Case Interpretation

Review Key Teaching Points



Mattu Class I Indications



Mattu Class IIa Indications



Mattu Class IIb Indications




Kudos: Big thanks to Drs. Patrick Bruss, Bill Brady, Jim Campagna, Nicolina Andersson, Mat Goebel, Devang Patel, Carlos Gutierrez, Tom Obrzut & Mr. Richard Jackson for sharing this week’s cases!

Notes: Questions for Amal? Email him at or find him on Twitter @amalmattu.

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