ECG Basics & Fundamentals: the value of clinical decisions instruments and what to do when evaluating patients with a concerning chest pain story

ECG Weekly Workout with Dr. Amal Mattu


A 68-year-old man with PMHx of HTN and cigarette smoking presents to the ED with severe central chest pain and mild shortness of breath for 1 hour. Pain is constant and heavy in nature with radiation into the left arm. There are no known alleviating or aggravating factors. Initial troponin is normal, and the following ECG is obtained on arrival:

Before watching the video, look closely at this ECG and ask yourself:

  1. What ECG abnormalities do you notice?
  2. How would you formally risk stratify and disposition this patient?
  3. What would you do next if the patient has ongoing chest pain despite medical treatment?