ECG Basics & Fundamentals: A stepwise approach to ECG interpretation in patients with chest pain and clinical concern for an acute coronary syndrome (ACS) with pearls and pitfalls in obtaining chest pain histories

ECG Weekly Workout with Dr. Amal Mattu


HPI: 61 year old male with significant cardiac risk factors presents with chest pain that that radiates down both arms. The pain is exertional and improves with rest. His pain is associated with nausea and diaphoresis.

Vitals: HR-50, SBP-90s, RR-18, SpO2-98%

Exam: Clear lungs, regular bradycardia, otherwise normal.

Before watching the video, ask yourself:

  1. What are the concerning historical features that increase or decrease the likelihood that this patient is having an acute coronary syndrome (ACS)?
  2. What is the rate and rhythm of the ECG above?
  3. What other abnormalities can you identify? Does the patient meet cath lab criteria?
  4. What should you do if the patient’s symptoms are not improving or changing?