ACS-OMI
Results:
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…
Ischemia & Infarction Interpretation
Key Points: The ECG is the fastest bedside tool for detecting acute coronary occlusion and dynamic ischemia, often before troponin changes and sometimes before classic symptoms. Acute coronary syndromes are…
Right Ventricular STEMI: Criteria & Pitfalls
Key Points: RV involvement accompanies up to ~40% of inferior STEMIs; isolated RV infarction is uncommon but high-impact when missed. Think RV MI when inferior STEMI is present and you…
Terminal QRS Distortion: OMI Pattern
Key Points: What it is: In V2 or V3, there is no S wave (the R does not descend below the PQ baseline) and no J wave (no notch/slur at…
Pseudonormalization of T Waves
Key Points Definition: Pseudonormalization is the apparent normalization of previously inverted T waves, often signaling reocclusion of a coronary artery that had recently reperfused. Mechanism: During reperfusion, ischemic T wave…
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
- 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 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
- 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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