Emergencies
Results:
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…
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 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…
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…
STEMI vs Severe Hyperkalemia: DDx
Key Points: Severe hyperkalemia is a true ECG chameleon. It can produce ST elevation, wide QRS complexes, axis shifts, and conduction blocks that closely mimic STEMI or ventricular tachycardia. New…
STEMI vs Acute Pericarditis: DDx
Key Points: Start by looking for STEMI, not pericarditis. The safest workflow is to actively search for occlusion MI features first, then use pericarditis features as supportive evidence. Reciprocal ST…
Traditional STEMI Criteria
Key Points: STAT ECG is the first decision point in ACS. The primary purpose of the initial ECG is to identify patients who meet traditional STEMI criteria and require immediate…
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…
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…
Hypomagnesemia
Key Points: Hypomagnesemia is an important arrhythmogenic electrolyte abnormality. It increases risk of atrial and ventricular ectopy, ventricular tachycardia, and torsades de pointes, especially when QT is prolonged. The most…
Arrhythmogenic Cardiomyopathy (ACM)
Key Points: Definition & Terminology: Arrhythmogenic Cardiomyopathy (ACM), previously known as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D), is an inherited disorder characterized by progressive fibrofatty replacement of the ventricular myocardium, predominantly…
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…
Pacemaker & ICD Emergencies
Key Points: Three primary pacemaker malfunctions: Failure to pace – no pacing spike when one is needed. Failure to capture – pacing spike appears but no depolarization follows. Failure to…
Himalayan T Waves
Key Points Tall, broad-based T–U fusion that looks like a mountain peak, usually from severe hypokalemia; think high torsades risk until proven otherwise. Hallmark is prolonged repolarization: QT appears long…
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…
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