Chest Pain
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Four ECGs Hiding a High-Risk Coronary Pattern
A 56-year-old man presents with 1 week of concerning chest pain and shortness of breath. His ECG does not meet conventional STEMI criteria, but it shows subtle ST-segment abnormalities in…
Three High Risk ECGs and the Right Next Move
A 34 year old man presents with acute chest pain radiating to the left arm associated with diaphoresis. He has hyperlipidemia and a family history of early coronary disease. The…
Post-Arrest STEMI: Cath Lab or Caution?
A 72-year-old man is brought to the ED after witnessed cardiac arrest. Bystander CPR was started quickly, EMS found a nonshockable rhythm, epinephrine was given, and ROSC was achieved. Forty…
UMEM Cases, Part 1: When the ECG Lies and When It Evolves
A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as…
Subtle ST Abnormalities and a Difficult Cath Lab Decision
A 60-year-old man presents with chest pain that seems a little better after belching, but his clinician is not reassured. The initial ED ECG shows subtle ST-segment abnormalities, the computer…
Three ECG Traps You Cannot Afford to Miss
A 60-year-old woman presents with palpitations and an irregular wide-complex tachycardia. The computer calls atrial fibrillation with a left bundle branch block, but a subtle clue in the precordial leads…
Reciprocal Depression in aVL: The Case for Serial ECGs
A 62-year-old man presents to the emergency department with acute chest pain associated with diaphoresis. He has cardiac risk factors including tobacco use. An initial 12-lead ECG is obtained on…
In the Era of High-Sensitivity Troponin, Does Unstable Angina Still Exist?
A 92-year-old man presents to the emergency department with gradually worsening dyspnea on exertion that has progressed to exertional chest “fullness”. He is asymptomatic on arrival with normal vitals. The…
Recent ECG Case Highlights from the University of Maryland (Part I)
A 64-year-old man is brought to the ED by EMS just after achieving return of spontaneous circulation following cardiac arrest. He received chest compressions, epinephrine, and was defibrillated prior to…
Not All Wide Complex Tachycardias Are What They Seem
A 40-year-old man presents with chest discomfort and shortness of breath. He’s ashen, diaphoretic, and hypotensive at 90/45. The ECG monitor shows a wide-complex regular tachycardia at 135 bpm concerning…
STEMI in a Postpartum Woman: A Case Against Risk Factor Bias
A 28-year-old woman, 1 week postpartum, calls 911 for acute chest pressure. She has no significant past medical history or traditional cardiac risk factors. Paramedics obtain the following prehospital ECG…
Cannabis Use and Premature Atherosclerosis: An ED Risk Factor To Ask About?
A 36-year-old man with hypertension and regular cannabis use (edibles, ~3x/week) is referred from clinic to the ED for chest pain and an abnormal ECG. His first ECG during pain…
Bradycardia, STEMI, and a Misleading Rhythm Diagnosis
A 68-year-old woman calls EMS after having a syncopal episode while using the bathroom. She reports associated chest pain over the past day. The following prehospital ECG is obtained:
Small ECG Changes, Big Clinical Wins: How Repeat ECGs Save Lives
A 64-year-old man with PMHx of hypertension and obesity presents to the emergency department with 2 days of worsening chest pain. Pain is central, intermittent, worsens with exertion, and has…
Aslanger’s Pattern and the Limits of Traditional STEMI Criteria
A 76-year-old man presents to the emergency department with shortness of breath, severe weakness, diaphoresis, and confusion. The following ECG is obtained on arrival:
2025 Clinical Guidelines for the Management of Acute Coronary Syndromes: Key Highlights
A 90-year-old woman presents to the emergency department with acute chest pain, nausea, and shortness of breath. She has two negative troponins 6 hours apart. The following ECG was obtained…
Concordance vs. Discordance: Recognition of Critical ECG Patterns
A 54-year-old woman presents to the emergency department with acute chest pain radiating to the jaw and left upper extremity. The following ECG is obtained:
Respect the T Wave: Early Clues to Cardiac Ischemia
A 54-year-old man presents to the emergency department with chest pain concerning for an acute coronary syndrome. An initial ECG is performed on arrival and appears normal, the following repeat…
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:
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:
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