STEMI

ECG STAT December 15, 2025

STEMI & Equivalent Patterns: Criteria & Pitfalls

Key Points STAT ECG: The most important initial test in evaluating acute coronary syndromes (ACS). The primary goal is to quickly identify patients with STEMI or STEMI-equivalent patterns that trigger…

Weekly Workout October 27, 2025

The Wide Complex Rhythm That Fooled Everyone

A 30-year-old woman presents with one hour of chest discomfort and palpitations. On arrival she is borderline but not frankly unstable. The 12-lead shows a fast rhythm that appears wide…

ECG STAT October 25, 2025

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…

Weekly Workout September 15, 2025

Not Your Usual STEMI: High Voltage and Narrow Q Waves

A 16-year-old male is referred to the emergency department from a primary care clinic with concern for STEMI. He has no known past medical history. At the clinic, he reported…

ECG STAT August 25, 2025

Takotsubo Cardiomyopathy vs STEMI: 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…

ECG STAT August 1, 2025

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…

ECG STAT July 4, 2025

Occlusion MI: STEMI Criteria & Beyond

Key Points A STAT ECG is the most critical first test in suspected acute coronary syndrome (ACS). It allows for early recognition of acute coronary occlusion myocardial infarction (OMI), a…

ECG STAT June 20, 2025

STEMI vs Wide QRS (BBBs & Paced Rhythms): DDx

Key Points Wide QRS & Repolarization Abnormalities: Bundle branch blocks (BBBs) and ventricular-paced rhythms (RV, LV, BiV) cause abnormal ventricular depolarization, leading to secondary ST segment and T wave changes—even…

ECG STAT April 1, 2025

Posterior STEMI: Criteria & Pitfalls

Key Points High Risk of Missed Diagnosis: Isolated posterior occlusion MI is frequently missed due to the absence of ST elevation on standard 12-lead ECG. Instead, ST depression in V1–V3…

Weekly Workout November 11, 2024

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:

Weekly Workout March 25, 2024

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…

Weekly Workout March 18, 2024

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:

Weekly Workout March 4, 2024

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…

Weekly Workout January 29, 2024

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:

Weekly Workout July 17, 2023

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…

Weekly Workout February 6, 2023

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…

Weekly Workout January 22, 2023

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:

Weekly Workout January 8, 2023

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…

Weekly Workout November 6, 2022

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…

Weekly Workout October 23, 2022

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…

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