Emergencies
Results:
Four ECGs Hiding a High-Risk Coronary Pattern
A 56-year-old man presents with 1 week of concerning chest pain and shortness of breath. His ECG does not meet conventional STEMI criteria, but it shows subtle ST-segment abnormalities in…
Three High Risk ECGs and the Right Next Move
A 34 year old man presents with acute chest pain radiating to the left arm associated with diaphoresis. He has hyperlipidemia and a family history of early coronary disease. The…
Barcelona Criteria in Left Bundle Branch Block (LBBB): OMI Pattern
Key Points: The Barcelona Criteria are ECG criteria proposed to identify acute myocardial infarction in patients with LBBB. Core problem: LBBB causes expected secondary ST-T changes, so standard STEMI millimeter…
Aslanger Pattern: OMI Pattern
Key Points: Aslanger pattern is an OMI pattern that can identify acute inferior occlusion despite not meeting traditional STEMI criteria. The key finding is ST segment elevation isolated to lead…
Occlusion MI in Left Bundle Branch Block (LBBB): STEMI Equivalent Pattern
Key Points: LBBB does not exclude acute coronary occlusion. LBBBs produce abnormal depolarization and expected secondary ST-T changes, which can mask or mimic ischemia. Acute occlusion MI can still be…
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…
Post-Cardiac Arrest ECGs Hub
Key Points: The first post-ROSC ECG is essential but imperfect. Obtain it immediately, but interpret it in context. Global ischemia, defibrillation, acidosis, hypothermia, vasopressors, artifact, and severe metabolic derangements can…
Post-Arrest STEMI: Cath Lab Decisions
Key Points: Persistent ST elevation after ROSC remains a guideline-supported indication for emergency coronary angiography. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends emergency angiography for patients after cardiac arrest with suspected…
Post-Arrest No STEMI: When Cath Can Wait
Key Points: Stable post-arrest patients without ST elevation should not go to reflex immediate cath solely because cardiac arrest occurred. Randomized trials in OHCA patients without ST elevation have not…
Pediatric ECG in Cardiac Arrest
Key Points: Pediatric arrest is usually respiratory, hypoxic, or shock-related, not primary coronary occlusion. The ECG still matters because it can reveal reversible metabolic, toxicologic, structural, inflammatory, or inherited electrical…
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…
The Cath Lab Was Activated, But Something Didn’t Fit
A 70-year-old woman with CHF, COPD, intermittent atrial fibrillation, chronic pain medication use, and recent poor intake develops sudden dyspnea at rest and is found somnolent and bradycardic in the…
Sinus Node Dysfunction (Sick Sinus Syndrome & Bradycardia-Tachycardia Syndrome)
Key Points: A spectrum, not a single rhythm: Sinus node dysfunction includes inappropriate sinus bradycardia, sinus pauses or arrest, SA exit block, chronotropic incompetence, and alternating atrial tachyarrhythmias with bradycardia….
Sinoatrial Exit Block
Key Points: Definition: Sinoatrial, or SA, exit block occurs when the sinus node generates an impulse that fails to conduct into the surrounding atrial tissue. The blocked impulse produces no…
Sinus Arrest
Key Points: Definition: Sinus arrest occurs when the sinus node temporarily fails to generate an impulse. This produces an absence of the expected P wave and its associated QRS complex….
UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135….
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…
Wide QRS Complex: DDx
Key Points: A QRS duration greater than 120 ms reflects delayed or abnormal ventricular depolarization. A wide QRS may be chronic and benign in context, or it may be the…
UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not
A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the…
Dysrhythmias in LVAD Patients
Key Points: Continuous-flow LVADs can mask cardiovascular collapse. Patients may remain awake during sustained VT or even VF because the pump can provide temporary flow. Treat the rhythm and the…
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