Emergencies
Results:
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…
Three More ECG Pitfalls That Punish Anchoring Bias
A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally…
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…
The Life Savers: Critical ECG Patterns
Key Points: Definition: Critical ECG patterns represent time-sensitive, life-threatening cardiac or systemic conditions that demand immediate recognition to prevent death or irreversible organ injury. These are the “can’t-miss” ECGs. Goal:…
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….
STEMI (-) Occlusion MI: OMI Patterns
Key Points: Traditional STEMI criteria miss many acute coronary occlusions. A substantial proportion of true OMIs do not meet classic millimetric STEMI thresholds. OMI is a pathophysiologic diagnosis, not an…
Prolonged QT Interval: DDx
Key Points: The QT interval reflects the time it takes for total ventricular depolarization and repolarization (Q wave onset to T wave end). QT prolongation increases the risk of torsades…
Hypocalcemia
Key Points: Prolonged QTc is the hallmark ECG change in hypocalcemia, driven mainly by ST-segment prolongation with relatively normal T-wave shape. Hypocalcemia can increase arrhythmia risk, including TdP, but TdP…
STEMI in the Presence of Baseline ECG Abnormalities
Key Points: Baseline ECG abnormalities do not protect patients from occlusion MI. They increase miss rates because they distort the ST segment and T waves. The core question is not…
Lateral and High-Lateral STEMI: Criteria, Localization, and Pitfalls
Key Points: Lateral and high-lateral STEMI often present with subtle ST elevation and are commonly missed or labeled as nonspecific ST-T changes. Small-appearing ECG changes may represent true coronary occlusion…
Inferior STEMI: Criteria, RV Involvement, and Pitfalls
Key Points: Inferior STEMI is the most common STEMI subtype and is frequently complicated by right ventricular and posterior involvement. Inferior occlusion may present with classic ST elevation, subtle ischemic…
Anterior STEMI: Criteria, Localization, and Pitfalls
Key Points: Anterior STEMI represents large myocardial territory at risk and carries the highest mortality among STEMI subtypes. Early recognition and reperfusion are critical. LAD occlusion may present with classic…
ECG Findings of LV Aneurysm
Key Points: Definition: A true LV aneurysm is a chronic, post transmural MI complication from scarred myocardium with akinetic or dyskinetic (paradoxical) wall motion. ECG hallmark: Persistent ST elevation in…
Wolff-Parkinson White (WPW) Syndrome
Key Points Pattern vs syndrome: WPW pattern = pre-excitation on ECG without symptoms. WPW syndrome = pattern plus tachyarrhythmia symptoms (palpitations, syncope, “seizure,” aborted sudden cardiac arrest). Mechanism: Congenital accessory…
Posterior STEMI: Criteria & Pitfalls
Key Points: High risk of missed diagnosis. Isolated posterior occlusion MI is frequently missed because ST elevation is absent on the standard 12-lead ECG. Instead, posterior infarction most often presents…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is a common, benign ECG pattern that most often appears in young, healthy patients. It can closely resemble acute anterior STEMI, creating a high-risk diagnostic…
STEMI vs LV Aneurysm: DDx
Key Points: LV aneurysm pattern is a post MI scar pattern with persistent ST elevation in the prior infarct territory, usually with pathologic Q waves and a stable, non evolving…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points: Pattern, not a STEMI equivalent. ST elevation in aVR (≥1 mm), often with ST elevation in V1 and diffuse ST depression (≥1 mm in ≥6 leads), represents high-risk…
STEMI Mimics: DDx
Key Points: ST elevation is a pattern, not a diagnosis. STEMI represents one cause of ST elevation and requires correlation with ECG morphology, distribution, evolution, and clinical context. Most ED…
Hyperkalemia Emergencies
Key Points: Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Severe hyperkalemia is one of the most dangerous ECG mimics in emergency medicine. It can resemble unstable bradyarrhythmias, VT, STEMI, and pacemaker…
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