Basics & Fundamentals

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:

Recent 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:

Recent 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,…

A Key Question That Clinches the Diagnosis

A 54-year-old man presents to the emergency department with nausea, vomiting, and lightheadedness. The following ECG is obtained:

Biphasic T Waves in Suspected Acute Coronary Syndrome

A 69-year-old man with PMHx of hypertension and polysubstance abuse presents to the emergency department for evaluation of exertional chest pain that resolves with rest. He is currently asymptomatic. The…

AI Advances in ECG Interpretation: Why Human Expertise Still Matters

2024 EMS Cases Part IV

A 60-year-old man is being transported by EMS to the emergency department for acute chest pain. The following ECG is transmitted prior to arrival as a “CODE STEMI” and brought…

Navigating a Very Abnormal QRS Axis with a Stepwise Approach

A 44-year-old woman presents to the emergency department with vague complaints about shortness of breath. The following ECG is obtained at triage and brought to you for interpretation:

Avoiding Misdiagnosis Through Proper Lead Placement

A 40-year-old man with no known medical problems presents with concerns about his cardiac health after a friend recently had an MI. He has no symptoms of acute coronary syndrome…

Key Points to Note About Complete Heart Block

A 70-year-old woman presents to the emergency department with lightheadedness and dizziness that is worse with standing. The following ECG is obtained:

Key Points to Note About Mobitz I & Mobitz II

A 49-year-old man presents to the emergency department after an episode of syncope. The following ECG is obtained:

Recent UMMC Cases

A 67 -year-old man presents to a busy emergency department with acute chest pain and shortness of breath. The following ECG is obtained, but he leaves without being seen because…

Concerning chest pain with ST segment depression in the anteroseptal leads (Part 2/2)

A 50-year-old woman presents to the emergency department with acute chest pain. The following ECG is obtained on arrival: