Basics & Fundamentals
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AFib Overdiagnosis: Dangerous Pitfalls and Safer Reads
A patient presents to the emergency department with new-onset palpitations. He is hemodynamically stable but noted to have an irregular rhythm on arrival. The following ECG is obtained and automatically…
Not Your Usual STEMI: High Voltage and Narrow Q Waves
A 16-year-old male is referred to the emergency department from a primary care clinic with concern for STEMI. He has no known past medical history. At the clinic, he reported…
STEMI Diagnosis: Beyond the Millimeters
A 55-year-old man with PMHx of hyperlipidemia presents to the emergency department with vague chest discomfort. The following ECG is obtained:
Regularly Irregular Rhythms: Sorting Mobitz from PACs and Other Causes
A 52-year-old woman presents to the emergency department with weakness. The following ECG is obtained:
Grouped Beats: A Subtle AV Block Pitfall
An elderly patient is brought to the emergency department with acute stroke symptoms and the following routine 12-lead ECG is obtained during the patient’s stroke evaluation:
High-Grade AV Block: New Perspectives and Important Clarifications
A 51-year-old man presents to the emergency department via EMS with nausea, vomiting, weakness, severe bradycardia (HR in the 20s), and hypotension (BP 60s systolic). The following ECG is obtained…
Mobitz I or Mobitz II: How to tell the difference
A 79-year-old man is sent to a community hospital for evaluation of bradycardia discovered at his nursing facility. He is ultimately transferred to a tertiary care facility for consideration of…
Recent University of Maryland Medical Center Cases (Part I)
A 67-year-old man presents to the emergency department with chest pain and palpitations. The following ECG is obtained on arrival:
Optical Illusions and 12-Lead ECGs: How First Impressions Can Mislead
A 42-year-old woman presents to the emergency department with chest pain, shortness of breath, and palpitations. Her blood pressure and mental status are noted to be normal. The following ECG…
Unrecognized Killers in Emergency Electrocardiography
A 42-year-old man presents with fever, cough, shortness of breath, and vomiting. He appears toxic and dehydrated on arrival with suspected severe sepsis from multilobar pneumonia. He is later intubated…
2025 In-Training Exam Preparation (Part III/III)
A 47-year-old male presents to the emergency department with acute chest and back pain. The following ECG is obtained, and concerning for diffuse ST segment elevation:
T Wave Clues: Uncovering Concealed Conduction Blocks and Arrhythmias
A 58-year-old man presents to the emergency department after an episode of syncope. The following ECG is obtained on arrival and interpreted as “sinus bradycardia”:
Anterior T Wave Inversions: Benign Variant or Hidden Danger?
A 31-year-old woman presents with chest discomfort that is worse with twisting and lifting. She denies any associated vomiting or worsening pain with exertion. The following ECG is obtained on…
Hyperacute T Waves: Distinguishing Early MI from Other Big T Wave Abnormalities
A 64-year-old man with PMHx of HTN, DM, and tobacco use presents with central chest pain that radiates to his left arm. The following ECG is obtained on arrival:
2024 UMMC Cases (Part II)
A 55-year-old woman arrives at the emergency department with shortness of breath and is noted to be tachypneic. The following ECG is obtained:
2024 UMMC Cases (Part I)
A 69-year-old man arrives at the emergency department with shortness of breath and profuse sweating. The ECG obtained below shows sinus tachycardia at a rate of ~ 130 bpm with…
When One Lead Stands Alone: Deciphering Bizarre ECG Abnormalities
A 67-year-old woman with PMHx of HTN, DM, and ESRD presents to the emergency department drowsy and non-cooperative. Her blood sugar is elevated, pH 7.23, and there is concern for…
How the Lewis Lead Can Improve Tachyarrhythmia Diagnosis
A 68-year-old woman presents to the emergency department with palpitations and tachycardia. The following ECG is obtained:
The Approach to Uncovering Hidden STEMI
A 92-year-old man presents to the emergency department with acute chest pain and diaphoresis. The following ECG is obtained:
Case Potpourri: Avoiding AFib Misdiagnosis, Recognizing Mobitz, and Managing Polymorphic V-Tach
A 50-year-old man is brought to the emergency department after successful resuscitation from a witnessed cardiac arrest. EMS was initially called to the scene for chest pain. While on scene,…
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