Early Signs of Ischemia
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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…
A Post-Arrest ECG With a Dangerous New Bundle Branch Block
A 72-year-old man is brought to the ED after a witnessed out-of-hospital cardiac arrest. Bystander CPR is started quickly, EMS finds a non-shockable rhythm, and ROSC is achieved after one…
UMEM Cases, Part 2: When the ECG Conceals and When It Reveals
An 81-year-old woman presents with lightheadedness and marked bradycardia. Her ECG shows more P waves than QRS complexes, but the mechanism is not immediately clear. The key question is whether…
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…
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…
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…
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 II)
A 72-year-old woman presents to the emergency department with lightheadedness and near-syncope. 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:
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…
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:
Is This a STEMI or STEMI Equivalent Pattern?
A 51-year-old man presents to the emergency department with acute chest pain that has progressively worsened over the past 3 hours. Pain radiates to the jaw and is associated with…
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…
Timeless ECG Lessons: Revisiting Classic Cases and Life Saving Interpretations
A 37-year-old man with no significant past medical history presents to the emergency department with acute chest pain and shortness of breath after a meal. He suspects he is having…
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…
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