Early Signs of Ischemia

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…

Subtle ECG Changes and Diagnostic Challenges

A 70-year-old male presents to the emergency department with acute chest pain that sounds ischemic in nature. The following baseline ECG, arrival ECG, and repeat ECGs are obtained:

Hyperacute T waves and serial ECGs in early ACS, AV blocks, and more on sustained vs. nonsustained ventricular tachycardia

An 80-year-old man presents to the emergency department after an episode of syncope. The following ECG is obtained:

STAT ECG Diagnoses: early ECG signs of cardiac ischemia and acute coronary occlusion

A 72-year-old woman is brought to the emergency department by EMS with acute chest pain and shortness of breath. The following ECG is obtained on arrival:

ECG Basics and Fundamentals: subtle early signs of acute cardiac ischemia

A 57-year-old man presents to the emergency department with chest pain concerning for MI. The following ECG is obtained with no prior ECGs available for comparison. Cardiology is contacted and…

Literature Review: subtle early signs of cardiac ischemia and the value of serial ECGs in patients being evaluated for acute coronary syndromes (ACS)

A 47-year-old man is brought to the ED by EMS for acute onset left sided chest pain. The history is concerning for an acute coronary syndrome.  The following ECG was…

ECG Basics & Fundamentals: new tall upright T waves in lead V1

A 53-year-old woman with PMHx of HTN and DM presents with atypical chest pain. She is noted to have a completely normal baseline ECG. The following ECG is obtained:

STAT ECG Diagnoses: how identification of ECG signs of early ischemia can effect disposition decisions in the emergency department

An elderly male presents to the ED with 2 hours of chest pain concerning for cardiac ischemia. The following ECG is obtained:

Differential Diagnoses: poor R wave progression and attention to T wave abnormalities

A 55-year-old woman presents with substernal chest pressure radiating to the left upper extremity, dyspnea, and nausea. She has a past medical history of HTN, DM, HLD, and is a…

STAT ECG Diagnoses: early reciprocal changes in patients with cliinical concern for ACS

A 87-year-old man reports having 2 days of central chest pain. He starts feeling worse on day 3 and calls an ambulance. Paramedics respond and are highly concerned for ACS…

EMS ECGs: respect lead aVL and looks for subtle early signs of cardiac ischemia

A 30-year-old woman is brought in by EMS to the ED with chest pain. The following prehospital ECG is obtained:

ECG Basics & Fundamentals: when a T wave inversion in lead aVL matters

A 45-year-old woman presents to the ED with severe heartburn. Her pain is associated with dyspnea and diaphoresis. The following ECG is obtained:

ECG Basics & Fundamentals: dynamic ischemic ECG changes in ACS

A 41-year-old male with no past medical history is brought into the ED with bilateral shoulder pain that has been intermittent throughout the day. On arrival the pain is mild,…

ECG Basics & Fundamentals: early signs of cardiac ischemia, poor R wave progression, and more!