Baltimore City EMS ECGs: Pitfalls and Mimics (Part 2)

Baltimore City EMS Cases with Dr. Amal Mattu

HPI

A 54-year-old man presents to the emergency department by EMS with acute shortness of breath. A prehospital ECG triggers a STEMI alert based on the computer interpretation. The tracing shows dramatic ST-segment abnormalities that appear convincing at first glance, but a systematic ECG review reveals a critical inconsistency that should make you pause before activating the cath lab.

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

    1. What ECG feature should immediately make you question a STEMI diagnosis when ST elevation appears dramatic?
    2. Which alternative life-threatening conditions can produce ST-segment changes that mimic STEMI in specific leads?
    3. How can a brief stepwise ECG approach prevent an unnecessary cath lab activation in this scenario?