Dr. Mattu’s 5 Favorite ECG Cases of 2025

UMEM Potpourri ECG Cases with Dr. Amal Mattu

HPI

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, but the tracing has additional clues that could change the urgency and destination of care.

Before watching this week’s workout, review the arrival ECG carefully and consider:

    1. With a ventricular rate in the 20s and high-grade AV block, what immediate bedside actions should happen in parallel while you interpret the rest of the ECG?
    2. When you see isolated ST elevation in lead III, what specific accompanying findings should make you worry about an occlusive coronary process even without classic “contiguous lead” STEMI criteria?
    3. How does recognizing this pattern change what you do next: pacing only, or simultaneous cath lab activation and reperfusion planning?