STAT ECG Diagnoses: what to do when the ST segment elevation in presumed STEMI resolves before patients get to the cath lab?

ECG Weekly Workout with Dr. Amal Mattu


 A 62-year-old woman is brought to the ED with severe chest pain radiating to the left shoulder. Pain is associated with shortness of breath, nausea, and diaphoresis. The following ECGs were obtained by EMS (1), obtained on arrival to the ED (2), and compared to an old ECG (3):

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

  1. What should you do when ST-segment elevation in presumed STEMI resolves before cath lab activation?
  2. Would you activate the cath lab on a patient with suspected STEMI who becomes asymptomatic or has resolution of ST elevation after medical treatment?