ACS-OMI

Weekly Workout May 11, 2026

Post-Arrest STEMI: Cath Lab or Caution?

A 72-year-old man is brought to the ED after witnessed cardiac arrest. Bystander CPR was started quickly, EMS found a nonshockable rhythm, epinephrine was given, and ROSC was achieved. Forty…

Weekly Workout May 4, 2026

A Post-Arrest ECG With a Dangerous New Bundle Branch Block

A 72-year-old man is brought to the ED after a witnessed out-of-hospital cardiac arrest. Bystander CPR is started quickly, EMS finds a non-shockable rhythm, and ROSC is achieved after one…

ECG STAT April 17, 2026

New RBBB + LAFB (Bifascicular Block) in ACS: OMI Pattern

Key Points: In a patient with ischemic symptoms, new RBBB + LAFB should raise concern for proximal LAD or septal ischemia until proven otherwise, especially if the patient has ongoing…

Weekly Workout April 6, 2026

UMEM Cases, Part 2: When the ECG Conceals and When It Reveals

An 81-year-old woman presents with lightheadedness and marked bradycardia. Her ECG shows more P waves than QRS complexes, but the mechanism is not immediately clear. The key question is whether…

Weekly Workout March 30, 2026

UMEM Cases, Part 1: When the ECG Lies and When It Evolves

A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as…

Weekly Workout March 23, 2026

Subtle ST Abnormalities and a Difficult Cath Lab Decision

A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer…

ECG STAT March 20, 2026

STEMI vs Wide QRS (BBBs & Paced Rhythms): DDx

Key Points: Wide QRS rhythms distort repolarization. Bundle branch block and ventricular pacing create secondary ST-T changes even without occlusion MI. Appropriate discordance is expected. ST segments and T waves…

ECG STAT March 20, 2026

South African Flag Sign: OMI Pattern

Key Points: Pattern: The South African Flag sign is the combination of ST elevation in I, aVL, and V2 with reciprocal ST depression in III. It is a subtle but…

Weekly Workout March 16, 2026

Three ECG Traps You Cannot Afford to Miss

A 60-year-old woman presents with palpitations and an irregular wide-complex tachycardia. The computer calls atrial fibrillation with a left bundle branch block, but a subtle clue in the precordial leads…

ECG STAT March 11, 2026

Occlusion MI in Ventricular Paced Rhythms: STEMI Equivalent Pattern

Key Points: Ventricular paced rhythms can mask acute coronary occlusion. Pacing alters depolarization and produces expected secondary ST-T abnormalities, so standard STEMI criteria are unreliable. Appropriate discordance is expected in…

ECG STAT March 11, 2026

Occlusion MI in Left Bundle Branch Block (LBBB): STEMI Equivalent Pattern

Key Points: LBBB does not exclude acute coronary occlusion. LBBB produces abnormal depolarization and expected secondary ST-T changes, which can mask or mimic ischemia. Acute OMI can still be recognized…

ECG STAT March 7, 2026

STEMI vs LVH: DDx

Key Points: Left ventricular hypertrophy (LVH) with strain is one of the most common and dangerous STEMI mimics, particularly in the anterior leads, and is a frequent cause of false-positive…

ECG STAT March 6, 2026

Modified Sgarbossa Criteria: STEMI Equivalent Pattern

Key Points: LBBB and ventricular-paced rhythms can hide acute coronary occlusion because abnormal depolarization creates expected secondary ST-T changes. Occlusion MI can still be recognized when those ST changes are…

ECG STAT February 14, 2026

Appropriate Discordance

Key Points: Appropriate discordance refers to the expected secondary ST segment and T wave pattern seen with abnormal ventricular depolarization, especially LBBB and ventricular-paced rhythm. The ST segment and T…

ECG STAT February 11, 2026

ST Depression: DDx

Key Points: ST depression is a pattern, not a diagnosis. It can represent ischemia, reciprocal change, baseline repolarization abnormalities, or noncardiac physiology. First split: regional (territorial) ST depression vs diffuse…

ECG STAT February 8, 2026

WPW Syndrome and Pseudo-MI Patterns

Key Points: WPW alters ventricular depolarization, producing secondary repolarization abnormalities that can mimic or mask myocardial infarction. ST-segment deviation in WPW is often non-ischemic, driven by abnormal activation via the…

Weekly Workout January 26, 2026

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

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…

Weekly Workout January 12, 2026

Four ECG Pitfalls That Punish Anchoring Bias

A 43-year-old woman with sharp left-sided chest pain and minimal cardiac risk factors has an initial ECG that is not diagnostic for STEMI. She looks stable, but one feature on…

ECG STAT January 11, 2026

Occlusion MI: STEMI Criteria & Beyond

Key Points: The ECG’s primary role in ACS is detecting acute coronary occlusion. Acute coronary occlusion myocardial infarction (OMI) is a time-critical diagnosis that requires immediate reperfusion. Time is myocardium….