Computer Interpreted ECGs
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Preexcitation Pitfalls (Part 1): The “Inferior STEMI” That Isn’t
A critically ill 38-year-old man presents hypotensive, pale, and diaphoretic with abdominal pain and rectal bleeding. Upright chest X-ray shows free air under the diaphragm, and the patient is headed…
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 1)
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The…
Dr. Mattu’s 5 Favorite ECG Cases of 2025
A 68-year-old man presents after syncope with profound bradycardia. The ECG shows a very slow ventricular rate with high-grade AV block. The reflex move is to focus only on pacing,…
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…
The Post-Thanksgiving Rhythm You Cannot Miss
A 48-year-old woman presents two days after Thanksgiving with severe weakness, palpitations, and mild chest discomfort. Her ECG appears to show a very wide complex regular tachycardia at 119 bpm.
Not Cerebral T Waves: The Beat-to-Beat Warning You Cannot Miss
A 71-year-old woman with baseline dementia presents with worsened confusion, nausea, and multiple episodes of vomiting over the past 24 hours. Her vital signs are reasonable and her exam is…
Recent ECG Case Highlights from the University of Maryland (Part III)
A 73-year-old man presents to the emergency department with nausea and vomiting. The following ECG was obtained on arrival and interpreted by the computer as “sinus tachycardia”, but something important…
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…
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…
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:
When to Default to VT and When to Doubt It
A 64-year-old man presents to the emergency department with palpitations. He was recently found to have an acute MI and is one day s/p RCA stenting. The following ECG is…
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:
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…
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:
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 EMS Cases Part II
A 57-year-old man is being brought in by EMS for generalized weakness and vomiting. The following ECG is obtained and transmitted as a CODE STEMI alert:
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