Literature Review: subtle early signs of cardiac ischemia and the value of serial ECGs in patients being evaluated for acute coronary syndromes (ACS)

Emergency Cardiology Literature Review & Updates with Dr. Amal Mattu


A 47-year-old man is brought to the ED by EMS for acute onset left sided chest pain. The history is concerning for an acute coronary syndrome.  The following ECG was obtained prior to arrival:

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

  1. Does this ECG meet STEMI criteria?
  2. Would you activate the cath lab?
  3. How frequently should non-diagnostic ECGs be repeated in patients being evaluated for ACS?