ACS-OMI
Results:
ST Depression V1-V4: OMI Pattern
Key Points: Most missed occlusion MI. Isolated posterior occlusion MI is frequently missed because the standard 12-lead ECG often lacks ST elevation. Instead, posterior injury appears as reciprocal anterior ST…
STEMI vs Takotsubo Cardiomyopathy: DDx
Key Points: Takotsubo (stress) cardiomyopathy is a transient, non-ischemic LV dysfunction—classically apical ballooning with basal hyperkinesis—often after emotional or physical stress. Presentation mimics occlusion MI (chest pain, ECG changes, elevated…
Earliest Evidence of Occlusion MI
Key Points: ACS is dynamic. Coronary arteries can occlude, partially reperfuse, and re-occlude over minutes to hours, and the ECG can show these shifts before biomarkers do. The earliest actionable…
Post-Thrombolytic Reperfusion ECG Findings
Key Points Reperfusion after fibrinolysis is a bedside diagnosis using a bundle of findings: symptoms, ECG trend, and hemodynamic/electrical stability. Best ECG marker of successful fibrinolysis: at least 50% ST-segment…
ECG Evidence of Reperfusion After Occlusion
Key Points Reperfusion and re-occlusion can occur spontaneously or after therapy. The ECG often reflects these changes earlier than symptoms. Most useful bedside ECG marker of reperfusion is ST-segment resolution…
Early Reciprocal Changes: OMI Pattern
Key Points STEMI criteria alone miss some acute coronary occlusions, so look for subtle “occlusion clues,” not just traditional STEMI criteria cutoffs. Minor ST elevation under 1 mm paired with…
Acute Coronary Syndromes (ACS)
Key Points: ACS is a clinical syndrome: classified by ischemic symptoms + ECG + troponin. ACS exists on a continuum of unstable angina, NSTEMI, STEMI, and patients can evolve between…
ST Depression in V1-V4: DDx
Key Points: Do not reflexively label ST depression in V1–V4 as “anterior ischemia/NSTEMI.” In ACS symptoms, posterior OMI is a major concern when the depression is most prominent in V1–V3…
de Winter T Waves: STEMI Equivalent Pattern
Key Points: STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). Treat the…
Pseudo-Wellens Waves
Key Points: Pseudo-Wellens waves are anterior T-wave patterns that mimic the biphasic or deeply inverted T waves of true Wellens syndrome but are caused by non-LAD, non-ischemic physiology. These normal-variant…
Wellens Syndrome
Key Points: Clinical diagnosis, not an ECG pattern alone. Wellens syndrome requires the characteristic ECG findings plus the appropriate clinical scenario. Morphology alone is insufficient and high-risk if misapplied. Critical…
Wellens Waves
Key Points: Clinical diagnosis, not an ECG pattern alone. Wellens syndrome requires the characteristic ECG findings plus the appropriate clinical scenario. Morphology alone is insufficient and high-risk if misapplied. Critical…
Shark Fin “Massive STEMI” Pattern
Key Points: High-risk STEMI morphology caused by fusion of the terminal QRS, J point, ST segment, and T wave into a single “triangular” deflection. Often massive apparent STE with loss…
Prominent Upright T Wave in V1
Key Points: Normal T Wave in V1: The normal ECG typically shows a flat or inverted T wave in lead V1 in sinus rhythm. An upright T wave in V1 can…
Spontaneous Coronary Artery Dissection (SCAD)
Key Points SCAD Definition: A spontaneous, non-atherosclerotic tear in the coronary artery wall, often affecting young, otherwise low-risk women (including peripartum patients). SCAD presents similarly to ACS and is an…
Tall R wave in V1: DDx
Key Points Normal expectation: In V1, the S wave is typically larger than the R wave. A tall or dominant R wave (R/S > 1) is abnormal and should prompt…
Tall R wave in aVR: DDx
Key Points Normal expectation: In aVR, the QRS is usually negative (deep S wave). A dominant or tall R wave (R > S) is abnormal and should prompt investigation. Mechanism:…
Hyperacute T Waves: OMI Pattern
Key Points: Complexity of ACS: Arteries can spontaneously reperfuse or re-occlude. Understanding early ECG patterns of early acute ischemia can help detect dynamic changes and prompt rapid interventions. ECG Pattern…
Isoelectric Segment of the ECG
Key Points: The reference for ST-segment shift is the J point relative to an isoelectric baseline. The two candidates for that baseline are the TP segment and the PR segment….
STEMI vs Artifact: DDx
Key Points: Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
ECG Tags
- A-Z
- ACS Mimics
- ACS-OMI
- Activation
- Advanced Level Curriculum
- Annual ECG Competition
- Anterior OMI
- Anterior STEMI
- Approach
- Arrest
- Arrhythmia
- Arrhythmogenic Cardiomyopathy
- Artifact
- ARVC
- ARVD
- Atrial Parasystole
- Attending
- AV Block
- aVF
- aVL
- aVR
- Axis
- Barcelona
- Basics
- Bix Rule
- Board Review
- Bradyarrhythmia
- Cath Lab
- Chest Pain
- Clumped Beats
- Competition
- Conduction
- Core
- Core Level Curriculum
- Critical ECG Patterns
- Curriculum
- DDx
- Delta
- Devices
- Diagonal Branch Occlusion
- Differential Diagnoses
- Diffuse ST Elevation
- Documentation
- Early Repolarization
- ECG Interpretation
- ECG Localization
- ECG Variant
- Education/Teaching
- Electrolytes
- Emergencies
- Emergent Cath Lab Activation
- EMS
- Expert Level Curriculum
- Flutter
- Flutter Waves
- Foundations Level Curriculum
- Guidelines
- High-Lateral STEMI
- Hub
- Hyperacute T waves
- Hypercalcemia
- Hyperkalemia
- Hypermagnesemia
- Hypocalcemia
- Hypokalemia
- Hypomagnesemia
- Hyponatremia
- Hypothermia
- I
- II
- Index
- Inferior OMI
- Inferior STEMI
- Intervals
- Irregular
- Ischemia
- Ischemia & Infarction
- J point
- J Waves
- JT
- Junctional Rhythm
- Juvenile T wave
- LAD Occlusion
- Lateral STEMI
- LBBB
- LCx Occlusion
- Lead Placement
- Left Atrial Enlargement (LAE)
- Life Savers
- LV an
- LV Aneurysm
- LVAD
- Mastery Level Curriculum
- Metabolic
- Mimics
- Morphology
- Narrow QRS
- Occlusion MI
- OMI Pattern
- Orthodromic AVRT
- Osborn Waves
- P Wave
- Paced Rhythms
- Pacemaker/ICD
- Paramedics
- Pauses
- PE
- Pediatrics
- Pericardial
- Pericarditis
- PGY-1
- PGY-2
- PGY-3
- PGY-4
- Post-Arrest
- post-arrest STEMI
- Post-Cardiac Arrest
- Posterior Extension
- Posterior MI
- Posterior STEMI
- potpourri
- PR
- Preexcitation
- Premature Complexes
- Prolonged QT
- Pulmonary Embolism
- Pulse-Tapping Artifact
- PVCs
- Q Wave
- QRS
- QT
- R Waves
- RAD
- Rate
- RBBB
- RCA Occlusion
- Regular
- Reperfusion
- Rhythm
- Right Atrial Enlargement (RAE)
- RR
- S Waves
- Segments
- Seizure
- Serial ECGs
- Sgarbossa
- Shock
- South African Flag Sign
- ST
- ST Depression
- ST Elevation
- STEMI
- STEMI Equivalent
- STEMI Mimics
- STEMI Negative OMI
- Stepwise
- Stroke
- Structural
- Students
- SVT
- Syncope
- T Wave Inversion
- T Waves
- Tachyarrhythmia
- Tachycardia
- Tamponade
- Terminal QRS Distortion
- Toxicology
- TP
- Traditional STEMI Criteria
- U Waves
- Unstable
- V1-V4
- V2
- V5
- V6
- Vectors
- Ventricular Repolarization
- Ventricular Rhythms
- Ventricular Tachycardia
- Voltage
- Waveforms
- Wide QRS
- Workflow
- WPW
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