STEMI
Results:
The Approach to Uncovering Hidden STEMI
A 92-year-old man presents to the emergency department with acute chest pain and diaphoresis. The following ECG is obtained:
Interesting Cases from UMMC (2024 – Part I/III)
A 63-year-old man presents to the emergency department with acute chest pain and an episode of syncope. The following ECG is obtained, and the cath lab is activated for suspected…
Literature Review: Shark Fin or “Triangular” ST segment morphology
A 61-year-old male is brought to the ED with acute substernal chest pain and diaphoresis. The following ECG is obtained:
Literature Review: Resolution of ST elevation in STEMI
Paramedics are transporting a middle aged male with chest pain and an obvious inferior STEMI. They arrive to the emergency department and the following ECG is obtained on arrival about…
2024 EMS Cases Part II
A 56-year-old woman is being brought in by EMS for palpitations. The following EMS ECG is obtained and transmitted:
STAT ECG Diagnoses: important considerations in hypotensive patients with acute cardiac ischemia
A 59-year-old man with no significant past medical history presents to the emergency department with chest pain, nausea, and shortness of breath for 1 hour. He appears diaphoretic on arrival…
STAT ECG Diagnoses: how to identify acute coronary occlusion myocardial infarction in patients with right bundle branch blocks (RBBB)
A 61-year-old man presents to the emergency department with acute chest pain associated with diaphoresis and appears pale. While obtaining a history and performing a physical exam the patient has…
STAT ECG Diagnoses: how to identify acute coronary occlusion MI in patients with LVH with strain pattern
A 60-year-old man presents to the emergency department with central chest pain for the last 2.5 hours concerning for cardiac ischemia. The following ECG is obtained on arrival:
STAT ECG Diagnoses: differential diagnoses for low voltage QRS complexes and ventricular arrhythmias in patients with left ventricular assist devices (LVADs)
An 82-year-old man is brought to the emergency department with confusion and decreased level of consciousness. He is noted to be hypotensive, bradycardic, hypothermic, and hypoglycemic. The following ECG is…
Literature Review: 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department Highlights
A 60-year-old man is brought into the emergency department by EMS for acute onset chest pain and diaphoresis concerning for an acute coronary syndrome. The following ECG is obtained on…
ECG Basics and Fundamentals: the earliest evidence of cardiac ischemia on the ECG and when to obtain serial ECGs
A 68-year-old man is brought into the emergency department for acute chest pain radiating to the back. He appears very uncomfortable and is hypertensive on arrival. A CT angiogram is…
ECG Basics and Fundamentals: PR segment or TP? the isoelectric baseline you should use to measure ST segment deviation
A 45-year-old woman presents to the ED with severe chest pain. She is minimally cooperative when trying to obtain a history and is requesting pain medication for severe pain. Physical…
STAT ECG Diagnoses: findings of occlusion MI in patients with right bundle branch block (RBBB)
A 51-year-old man presents to the emergency department with acute chest pain and shortness of breath. The following ECG is obtained with no priors available for comparison:
STAT ECG Diagnoses: what to do when the ST segment elevation in presumed STEMI resolves before patients get to the cath lab?
A 62-year-old woman is brought to the ED with severe chest pain radiating to the left shoulder. Pain is associated with shortness of breath, nausea, and diaphoresis. The following ECGs…
STAT ECG Diagnoses: using ectopy and premature ventricular contractions (PVCs) to diagnose occlusion MI
A 62-year-old woman is brought to the ED by EMS with severe chest pain, shortness of breath, nausea, and diaphoresis. The following EMS ECG was obtained:
STAT ECG Diagnoses: antiarrhythmic considerations in patients with unstable irregular tachydysrrhythmias
A 29-year-old male with no significant known PMHx presents to the ED with palpitations. He is found to be markedly tachycardic on arrival. The following ECG is obtained:
Literature Review: diagnosis of acute coronary occlusion myocardial infarction in patients with ventricular paced rhythms
A 65-year-old woman presents to the ED with chest pain and diaphoresis concerning for an acute coronary syndrome. The following ECG is obtained:
STAT ECG Diagnoses: the basics of left bundle branch blocks (LBBB) and how to identify occlusion MI in these patients
A 65-year-old man presents to the ED with chest pain and diaphoresis concerning for an acute coronary syndrome. The following ECG is obtained:
STAT ECG Diagnoses: any ST segment elevation in patients with right bundle branch blocks (RBBB) is abnormal!
HPI: A 70-year-old male with PMHx of HTN, DM, CKD, and CAD is brought to the emergency department with chest pain and shortness of breath. The following ECG is obtained…
STAT ECG Diagnoses: the ECG in patients with significant left ventricular hypertrophy (LVH) and how to identify occlusion MI in these patients (part 2/2)
LVH with strain pattern may mimic anterior coronary occlusion and is known to be a common cause of “false-positive” cath lab activations. The following prehospital ECGs were obtained in patients…
ECG Tags
- & Myocardial Ischemia
- 11th Annual UMEM ECG Competition
- 12th annual UMEM Residency ECG competition
- 13th annual ECG competition
- 1st degree AV Block
- 1st degree AVB
- 2:1 AV Block
- 2:1 AVB
- 2:1 Conduction
- 2015 ECG Competition
- 2015 ECG Competition Part II
- 2016 ECG Competition
- 2017 ECG Competition Part II
- 2018 ECG Competition Part II
- 2019 ECG Competition
- 2020 ECG Competition
- 2024 ECG Competition
- 2025 ACC/AHA/ACEP/NAEMSP/SCAI Clinical Practice Guidelines for the Management of Patients with Acute Coronary Syndromes
- 2025 ACS guidelines
- 3rd degree AV block
- 5 Step Approach
- 5-FU
- aberrancy
- Aberrant conduction
- Abnormal ECG
- Abnormal P wave Axis DDx
- Abnormal STAT ECG
- absent p waves
- Accelerated idioventricular rhythm
- accelerated junctional rhythm
- Acidosis
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- ACS mimics
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- Acute Chest Pain
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- Acute Coronary Syndromes (ACS)
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- Acute Pericarditis
- Acute Pericarditis vs. STEMI
- Adenosine
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- Advanced AV block
- Afib
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- AI
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- arrhythmogenic cardiomyopathy
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- Artifact
- artifact vs. malignant arrhythmias
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- artifact vs. ventricular fibrillation
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- atrial fibrillation with complete heart block
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- atrial flutter 2:!
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- atrial flutter mimics
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- Atrial Septal Defect (ASD) & Crochetage Pattern
- Atrial tachycardia
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- Atrioventricular Blocks (AVB) Summary
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- AV Blocks
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- BBB
- BBBs & Paced Rhythms vs. STEMI
- Benign early repolarization
- BER
- Beta-Blocker (BB) and Calcium Channel Blocker (CCB) Toxicity
- bidirectional ventricular tachycardia
- bifascicular block
- bifid p waves
- bigeminy
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- Board review
- bpm
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- Bundle Branch Blocks
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- cannabis
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- CCB toxicity
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- child ecg
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- clumped beats
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- cocaine
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- congenital long QT syndrome
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- Crochetage
- Crochetage pattern
- ddx
- DDx for TWIs in V1-V3
- de Winter
- de Winter T-wave
- de Winter T-waves
- defibrillation
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- deWinter
- deWinter T-waves
- Dextrocardia
- differential diagnoses
- differential diagnoses for left axis deviation
- Diffuse ST elevation
- Diffuse ST Elevation DDx
- Diffuse ST-segment Elevation
- Diffuse STE
- dig effect
- digoxin
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- DKA
- Dominant R wave
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- dresslers
- dresslers syndrome
- dynamic ecg changes
- Dysrhythmia
- Dysrhythmia in LVADs
- Dysrhythmias
- Earliest ECG Evidence of Occlusion MI
- Earliest Evidence of Occlusion MI
- Early cardiac ischemia
- Early ECG evidence of ischemia
- Early ischemia
- Early ischemic changes
- Early reciprocal changes
- Early Repolarization
- early repolarization vs/ STEMI
- early signs of cardiac ischemia
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- Early STEMI
- ecg 101
- ECG Basics
- ECG competition
- ECG Competition 2023
- ECG Evidence of Reperfusion After Occlusion
- ecg history
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- Ectopic atrial rhythm
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- Electrolytes
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- Emergent cath lab activation
- EMS
- EMS cases
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- EMS ECGs in Acute Coronary Syndromes (ACS)
- Epsilon waves
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- escape rhythms
- Escape-Capture
- Escape-Capture Bigeminy
- evolution of ecg
- Evolving STEMI
- extreme axis deviation
- Extreme Axis Deviation Basics
- Extreme Axis Deviation DDx
- Extreme Axis Deviation Differentials
- failure to capture
- failure to pace
- failure to sense
- Fascicular blocks
- fever
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- Flattened T Waves
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- Framingham formula
- Fridericia formula
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- Guidelines
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- heart rate and rhythm basics
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- High grade AV block
- high grade AV blocks
- high lateral STEMI
- high left ventricular voltages and 'dagger like' Q waves
- high risk pe
- High Voltage
- High-Grade (Advanced AV Block)
- high-risk pulmonary embolism
- Himalayan T-waves
- history of ecg
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- HOCM
- Hodges formula
- Hypeacute T waves
- hyperacute
- Hyperacute T-waves
- Hypercalcemia
- Hyperkalemia
- Hyperkalemia emergencies
- hyperkalemia mimics
- Hyperkalemia vs. STEMI
- Hyperkalemia vs. VT
- Hyperkalemic paralysis
- Hyperkalemic Periodic Paralysis
- Hyperkalemic Periodic Paralysis (“Impressive Syndrome”)
- Hypermagnesemia
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- Hypertrophic Cardiomyopathy
- Hypertrophic obstructive cardiomyopathy
- Hypocalcemia
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- hypokalemia emergencies
- Hypokalemic paralysis
- hypokalemic periodic paralysis
- Hypomagnesemia
- hyponatremia
- Hypothermia
- Idioventricular rhythms
- Impressive syndrome
- in-training exam
- inappropriate sinus tachycardia
- incomplete right bundle branch block
- indeterminate axis
- Indeterminate Axis DDx
- Indeterminate Axis differentials
- indeterminate QRS axis
- inferior STEMI
- inservice exam
- intermittent
- Intermittent WPW
- intervals
- Intracranial hemorrhage
- Intractable chest pain
- inverted P Waves
- Inverted T Waves
- Inverted U-waves
- IRBBB
- Irregular rhythm
- irregular rhythms
- Ischemia
- Ischemia & Infarction
- Ischemic T-waves
- Isoelectric baseline
- Isoelectric segment
- Isoelectric Segment of the ECG
- Isolated Posterior STEMI
- Isorhythmic AV dissociation
- Isorhythmic AVD
- ITE prep
- ITE review
- J point
- J wave
- J-waves
- Jervell
- Jervell and Lange-Nielsen Syndrome
- JLNS
- Josephson Sign
- Josephson’s sign
- junctional escape
- junctional escape capture bigeminy
- junctional escape rhythms
- junctional rhythm
- Junctional rhythms
- Junctional Tachycardia
- Juvenile T wave inversions
- Juvenile T waves
- Juvenile T-wave pattern
- kid
- kid ecg
- kids
- killer differentials
- LAD
- LAD OMI
- LAE
- LAFB
- Lange
- Large T Wave DDx
- Large T-waves
- LBBB
- LBBB DDx
- lead misplacement
- lead V1
- left anterior fascicular block
- Left Atrial Enlargement
- Left axis deviation
- left axis deviation ddx
- left bundle branch block
- left posterior fascicular block
- Left Ventricular Hypertrophy (LVH)
- Left ventricular hypertrophy vs. STEMI
- lewis
- Lewis lead
- LGL
- life savers
- limb lead misplacement
- Limb lead reversal
- Literature review
- Long QT
- Long QT Interval DDx
- Long QT-interval
- Long QTc
- long ST segment
- Low Voltage
- low voltage differential
- Low voltage QRS
- Low Voltage QRS DDx
- LPFB
- LQT1 (KCNQ1 Mutation)
- LQT2 (KCNH2 Mutation)
- LQT3 (SCN5A Mutation)
- LQTS
- LV Aneurysm
- LV Aneurysm vs. STEMI
- LVAD
- LVAD Dysrhythmias
- LVADs
- LVH
- LVH vs. STEMI
- LVH with strain pattern
- Lyme carditis
- Marijuana
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- Massive STEMI
- MAT
- Mechanisms of ACS
- Metabolic Emergencies
- Methamphetamine Toxicity
- MI
- mimics
- misplaced leads
- Mobitz
- Mobitz conduction
- Mobitz I
- Mobitz I (Wenckebach)
- Mobitz I or Mobitz II: How to tell the difference
- Mobitz II
- Mobitz II (Hay)
- Mobitz II AV block
- modified lead
- Modified Sgarbossa criteria
- Monomorphic Ventricular Tachycardia
- monomorphic VT
- Multifocal atrial tachycardia
- Myocarditis
- Myxedema
- Na channel blocker toxicity
- narrow & irregular tachycardia
- narrow & regular tachycardia
- Narrow complex and regular rhythms
- Narrow complex irregular rhythms
- Narrow complex irregular tachycardia
- Narrow Complex Regular Tachycardia
- narrow complex regular tachycardia differential
- Narrow Complex Tachycardia
- narrow qrs bradycardia
- Narrow QRS Bradycardia DDx
- New Q Waves
- New RBBB and LAFB
- Nielsen
- Nikelekam T-waves
- No clear P waves DDx
- no man's land
- Non-conducted P wave (P:QRS>1) DDx
- non-conducted P waves
- non-conducted PACs
- Non-STE ACS
- Non-sustained Ventricular tachycardia
- Non-sustained VT
- Nonspecific intraventricular conduction delay
- nonsustained
- nonsustained ventricular tachycardia
- Nonsustained VT
- normal
- Normal Cardiac Conduction
- Normal ECG
- normal heart rate
- Normal Heart Rate Ranges by Age
- normal lead placement
- normal qrs axis
- Normal R wave progression
- Normal Sinus Rhythm
- Normal STAT ECG
- Normal variant patterns
- normal variant ST elevation
- Normal variants
- Not Enough P Waves (P:QRS < 1) DDx
- Not normal ecg
- NSVT
- Occlusion MI
- Occlusion MI - STEMI Criteria & Beyond
- Occlusion MI patterns
- OMI
- OMI pa
- OMI Pattern
- OMI Pattern: ST Depression V1-V4
- OMI Patterns in Left Bundle Branch Block
- OMI Patterns in Ventricular Paced Rhythms
- OMI Patterns: STEMI (-) Occlusion MI
- Opiate Toxicity
- orthodromic
- orthodromic SVT
- Osborn waves
- overdose
- p mitrale
- p pulmonale
- p waves
- P.E.
- PAC
- PAC’s
- Paced rhythms
- Pacemaker
- Pacemaker emergencies
- pacemaker malfunction
- Pacer
- palpitations
- Pauses and clumped beats
- PE
- PE vs. STEMI
- peaked P waves
- Pediatric ECG
- Pediatric ECG Interval Table
- Pediatrics
- Pericardial effusion
- Pericardial Tamponade
- Pericarditis
- pericarditis vs acs
- Pericarditis vs. STEMI
- Periodic paralysis
- Persistent juvenile T-wave pattern
- PFO
- PGY-2 (Intermediate) Resident Curriculum
- PGY-3 (Advanced) Resident Curriculum
- PGY1 Curriculum
- PJC
- PJCs
- PJTW
- plaque rupture
- plaque vulnerability
- PMVT
- Pokey T wave
- Polymorphic Ventricular Tachycardia
- Polymorphic VT
- Polyuria
- Poor R-wave progression
- post arrest ECG
- post cardiac arrest ECGs
- post-arrest
- Post-Arrest ECG for Dysrhythmias
- Post-Arrest ECG for Ischemia
- Post-arrest NSTE-ACS
- Post-arrest STEMI
- post-cardiac arrest ecg
- post-mi pericarditis
- Post-Thrombolytic Reperfusion ECG Findings
- Posterior MI
- Posterior Occlusion MI
- POSTERIOR OMI
- Posterior STEMI
- Posterior STEMI Criteria
- postural orthostatic tachycardia syndrome
- Potpourri
- POTS
- PR interval
- PR segment
- PR segments
- Pre-hospital ECG
- precordial lead misplacement
- precordial swirl
- preexcitation
- preexcitation syndrome
- Preexcitation syndromes
- preexcited af
- preexcited atrial fibrillation
- Pregnancy
- Prehospital ECG
- premature atrial complexes
- Premature beats
- Premature complexes
- premature contractions
- premature junctional complexes
- Prolonged QT
- Prolonged QT interval
- prolonged QTc
- Proper ECG Lead Placement
- proper lead placement
- proportionality
- PRWP
- Pseudo Wellens
- Pseudo-Wellens waves
- Pseudonormalization of T-waves
- Pulmonary Embolism
- pulmonary hypertension
- Pulse tapping artifact
- pulse-tapping
- PVC
- PVCs
- PVT
- Q-waves
- QRS
- QRS axis
- qrs axis basics
- QRS Complexes
- QRS fragmentation
- QRS Fragmentation (fQRS)
- QRS morphology
- qrs voltage
- QRS-interval
- QRS-T proportionality
- QT interval
- QT Interval Basics
- QTc interval
- R wave basics
- R waves
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- R-wave
- R-wave in V1
- R-wave progression
- RAD
- RAE
- rapid af
- rapid afib
- rapid atrial fibrillation
- rate & rhythm
- RBBB
- Really wide complex tachycardia
- reciprocal changes
- Recommended ECG Books
- Reflux
- refractory ischemia
- Regular Really Wide Complex Tachycardia
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- Regularized atrial fibrillation
- Regularly Irregular Rhythm
- repeat ecg
- repolarization abnormalities
- Rescue PCI
- Resolved ST segment elevation
- Resources & Recommendations
- Respiratory variation
- Retrograde P waves
- Reverse R wave progression
- Revised Sgarbossa Criteria
- Rhythm
- Rhythm Interpretation
- right atrial enlargement
- Right axis
- Right Axis Deviation
- Right Axis Deviation + STE DDx
- Right Axis Deviation + STE Differential
- Right Axis Deviation Basics
- Right Axis Deviation DDx
- Right bundle branch block
- right heart strain
- Right sided leads
- Right Ventricular (RV) STEMI Criteria
- Right Ventricular Hypertrophy
- Rightward axis
- rollercoaster T waves
- RRWCT
- RV MI
- RV Outflow Tract Tachycardia (RVOT)
- RV STEMI
- rvh
- RVH with strain
- RVMI
- RWCT
- S wave
- S waves
- s5
- SAH
- Salvador Dali
- SANRT
- SCAD
- second degree av block
- Second-Degree AV Block Type I (Mobitz I / Wenckebach)
- Second-Degree AV Block Type II (Mobitz II)
- Second-Degree AV Block with 2:1 Conduction
- segments
- Seizure
- Seizures
- Septal STEMI
- Serial ECG
- Serial ECGs
- Severe Hyperkalemia
- Severe Hypothermia
- Severe hypothyroidism
- Sgarbossa
- Sgarbossa Criteria
- Shark fin morphology
- Shark fin STEMI
- Short PR interval
- Short QT
- Short QT interval
- Short QT Syndrome
- Short QTc
- Shortened QT
- SHS
- sick sinus syndrome
- Sinoatrial Exit Block
- Sinoatrial Nodal Reentry Tachycardia
- Sinoatrial Nodal Reentry Tachycardia (SANRT)
- Sinus arrest
- sinus arrhythmia
- sinus bradycardia
- sinus inversus totalis
- Sinus Node Dysfunction
- Sinus Node Dysfunction (Sick Sinus Syndrome
- sinus rhythm
- Sinus rhythms
- Sinus Tachycardia
- situs inversus
- situs inversus totalis
- Sloof Lirpa Sign
- Slow Atrial fibrillation
- slow ventricular tachycardia
- slow vt
- Sodium channel blocker toxicity
- South Africa
- South Africa sign
- South African
- South African Flag Sign
- spiked
- Spiked Helmet sign
- spiked-helmet
- Spodick Sign
- Spodick’s Sign
- Spontaneous Coronary Artery Dissection
- Spontaneous Coronary Artery Dissection (SCAD)
- ST
- ST depression
- ST depression differential
- ST Depression in V1-V4 DDx
- ST depression V1-V4
- ST Elevation
- ST Elevation DDx
- ST Elevation in aVR DDx
- ST segment elevation
- ST Segment Elevation in aVR with Multi Lead ST Segment Depression
- ST-segment
- ST-segment depression
- stat
- stat ecg
- stat ecgs
- STD
- STE
- STE differential diagnosis
- STE in aVR
- steeple sign
- Steeple sign in V1
- STEMI
- STEMI Criteria
- STEMI Criteria & STEMI Equivalent Patterns
- STEMI diagnosis
- STEMI equivalent
- STEMI equivalents
- STEMI mimics
- STEMI vs. acute pericarditis
- STEMI vs. Early repolarization
- STEMI vs. Severe Hyperkalemia
- stepwise approach
- strain
- Stress Testing
- Stress tests
- Student Level Curriculum
- Subtle ST elevation
- Subtle ST Segment Elevation (STE)
- subtle stemi
- Supraventricular tachycardia
- Supraventricular Tachycardia (SVT)
- Sustained VT
- SVT
- synchronization
- Syncop
- Syncope
- syncope ddx
- syncope differentials
- syncope emergencies
- Systematic approach to ECG
- T wave
- T wave inversion differential
- T Wave Inversion in V1-V3 DDx
- T wave inversions in V1-V3
- T wave morphology
- T-wave abnormalities
- T-wave alternans
- T-wave inversion
- T-wave inversions
- T-waves
- Tachycardia
- Takotsubo Cardiomyopathy
- Takotsubo Cardiomyopathy vs. STEMI
- Tall R wave in aVR
- Tall R wave in V1
- Tamponade
- TCA
- TCA overdose
- TCA toxicity
- TdP
- Terminal QRS distortion
- Terminal QRS Distortion (OMI Pattern)
- the basics
- The Bix Rule
- The Bix Rule – Unmasking Atrial Flutter
- The Curriculum
- third degree AV block
- Third-Degree AV Block (Complete Heart Block)
- Thrombolytics
- too many P waves
- Too Many P Waves (P:QRS>1) DDx
- Top 10 cases of the past 10 years
- Torsades
- Torsades de pointes
- Torsades de Pointes risk
- torsades de points
- Toxicologic Emergencies
- Toxicology
- TP segment
- Transient STEMI
- Tremor artifact
- trifascicular block
- Trigeminy
- Troponin
- troponins
- TWI
- Type A Wellens
- Type B Wellens
- U-waves
- Understanding ECG Artifacts
- unifascicular
- unstable angina
- unstable bradycardia
- unstable tachyarrhythmia
- unstable tachycardia
- Upright T waves in V1
- urgent cath
- V1
- v1-v2 placed too high
- V1/V2
- vasospasm
- Ventricular aneurysm
- Ventricular dysrhythmias
- ventricular escape rhythms
- Ventricular fibrillation
- ventricular fibrillation mimics
- Ventricular Flutter
- Ventricular rhythm
- Ventricular rhythms
- Ventricular Tachycardia
- Ventricular Tachycardia (VT)
- Ventricular tachycardia mimics
- Ventricular tachycardia vs. SVT with aberrant conduction
- Ventricular Tachycardiak
- Vereckei aVR
- VF
- voltage
- VT
- VT mimics
- VT vs. SVT with Aberrancy
- w Voltage
- waveforms
- waves
- WCT
- Wellens
- Wellens waves
- Wellens’ syndrome
- Wide & Regular Tachydysrhythmia DDx
- wide complex irregular tachycardia
- Wide complex QRS
- wide complex regular tachycardia
- Wide complex tachycardia
- Wide QRS
- Wide QRS (BBBs & Paced Rhythms) vs. STEMI
- wide qrs bradycardia
- Wide QRS Complex DDx
- wide qrs differential
- Wide QRS interval
- wide vs. narrow QRS
- Wolff Parkinson White
- Wolff-Parkinson White (WPW) Syndrome
- WPW
- wpw syndrome
- WPW syndrome and Pseudo-MI patterns
- WPW vs STEMI
- WPW with Antidromic SVT
- WPW with atrial fibrillation
- WPW with Orthodromic SVT
- WPW with SVT
- Young patients
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