Baltimore City EMS ECGs: Pitfalls and Mimics (Part 1)

Baltimore City EMS Cases with Dr. Amal Mattu

HPI

A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The computer interprets the tracing as having signs of both early repolarization and ischemia.

Before watching this week’s workout, review the prehospital ECG carefully and consider:

    1. What single ECG finding immediately rules out benign early repolarization, even when ST elevation appears concave?
    2. Which leads can be safely ignored when evaluating for ST depression, and which cannot?
    3. How can reliance on morphology alone delay recognition of an occlusive coronary lesion?