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Dr. Mattu’s 5 Favorite ECG Cases of 2025
A 68-year-old man presents after syncope with profound bradycardia. The ECG shows a very slow ventricular rate with high-grade AV block. The reflex move is to focus only on pacing,…
Reciprocal Depression in aVL: The Case for Serial ECGs
A 62-year-old man presents to the emergency department with acute chest pain associated with diaphoresis. He has cardiac risk factors including tobacco use. An initial 12-lead ECG is obtained on…
In the Era of High-Sensitivity Troponin, Does Unstable Angina Still Exist?
A 92-year-old man presents to the emergency department with gradually worsening dyspnea on exertion that has progressed to exertional chest “fullness”. He is asymptomatic on arrival with normal vitals. The…
The Post-Arrest Wide Complex Rhythm That Was Not VT
A 35-year-old woman arrives at the emergency department after a witnessed seizure and brief cardiac arrest with ROSC. Her arrival ECG shows a very wide complex rhythm that the machine…
The Post-Thanksgiving Rhythm You Cannot Miss
A 48-year-old woman presents two days after Thanksgiving with severe weakness, palpitations, and mild chest discomfort. Her ECG appears to show a very wide complex regular tachycardia at 119 bpm.
ST Elevation and Biphasic T Waves in a Young Man: Wellens, Anterior STEMI, or Something Else?
A 38-year-old Kenyan man presents to a Haitian clinic with three days of low sternal and epigastric pain radiating to the neck, plus exertional dyspnea while working in a hot…
Not Cerebral T Waves: The Beat-to-Beat Warning You Cannot Miss
A 71-year-old woman with baseline dementia presents with worsened confusion, nausea, and multiple episodes of vomiting over the past 24 hours. Her vital signs are reasonable and her exam is…
Recent ECG Case Highlights from the University of Maryland (Part III)
A 73-year-old man presents to the emergency department with nausea and vomiting. The following ECG was obtained on arrival and interpreted by the computer as “sinus tachycardia”, but something important…
Recent ECG Case Highlights from the University of Maryland (Part II)
A 67-year-old man arrives at the emergency department complaining of lightheadedness. The following ECG is obtained and shows a slow, regular rhythm around 40 beats per minute. The P waves…
Recent ECG Case Highlights from the University of Maryland (Part I)
A 64-year-old man is brought to the ED by EMS just after achieving return of spontaneous circulation following cardiac arrest. He received chest compressions, epinephrine, and was defibrillated prior to…
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…
Not All Wide Complex Tachycardias Are What They Seem
A 40-year-old man presents with chest discomfort and shortness of breath. He’s ashen, diaphoretic, and hypotensive at 90/45. The ECG monitor shows a wide-complex regular tachycardia at 135 bpm concerning…
AFib Overdiagnosis: Dangerous Pitfalls and Safer Reads
A patient presents to the emergency department with new-onset palpitations. He is hemodynamically stable but noted to have an irregular rhythm on arrival. The following ECG is obtained and automatically…
STEMI in a Postpartum Woman: A Case Against Risk Factor Bias
A 28-year-old woman, 1 week postpartum, calls 911 for acute chest pressure. She has no significant past medical history or traditional cardiac risk factors. Paramedics obtain the following prehospital ECG…
Cannabis Use and Premature Atherosclerosis: An ED Risk Factor To Ask About?
A 36-year-old man with hypertension and regular cannabis use (edibles, ~3x/week) is referred from clinic to the ED for chest pain and an abnormal ECG. His first ECG during pain…
Syncope with High Voltage: The Yamaguchi Pattern
52-year-old man with PMHx of hypertension presents after a witnessed syncopal episode at home. He felt lightheaded while standing to use the bathroom and briefly lost consciousness without seizure activity…
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…
Really Wide, Kind of Slow: VT vs. Toxicity
A 78-year-old woman with PMHx of atrial fibrillation presents to the emergency department with generalized weakness. She is noted to be tachycardic on arrival, is known to be on flecainide…
STEMI Diagnosis: Beyond the Millimeters
A 55-year-old man with PMHx of hyperlipidemia presents to the emergency department with vague chest discomfort. The following ECG is obtained:
When to Default to VT and When to Doubt It
A 64-year-old man presents to the emergency department with palpitations. He was recently found to have an acute MI and is one day s/p RCA stenting. The following ECG is…
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