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ST Elevation and Biphasic T Waves in a Young Man: Wellens, Anterior STEMI, or Something Else?
A 38-year-old Kenyan man presents to a Haitian clinic with three days of low sternal and epigastric pain radiating to the neck, plus exertional dyspnea while working in a hot…
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 II)
A 67-year-old man arrives at the emergency department complaining of lightheadedness. The following ECG is obtained and shows a slow, regular rhythm around 40 beats per minute. The P waves…
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…
The Wide Complex Rhythm That Fooled Everyone
A 30-year-old woman presents with one hour of chest discomfort and palpitations. On arrival she is borderline but not frankly unstable. The 12-lead shows a fast rhythm that appears wide…
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…
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…
Syncope with High Voltage: The Yamaguchi Pattern
52-year-old man with PMHx of hypertension presents after a witnessed syncopal episode at home. He felt lightheaded while standing to use the bathroom and briefly lost consciousness without seizure activity…
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…
Really Wide, Kind of Slow: VT vs. Toxicity
A 78-year-old woman with PMHx of atrial fibrillation presents to the emergency department with generalized weakness. She is noted to be tachycardic on arrival, is known to be on flecainide…
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:
High-Grade AV Block: New Perspectives and Important Clarifications
A 51-year-old man presents to the emergency department via EMS with nausea, vomiting, weakness, severe bradycardia (HR in the 20s), and hypotension (BP 60s systolic). The following ECG is obtained…
Mobitz I or Mobitz II: How to tell the difference
A 79-year-old man is sent to a community hospital for evaluation of bradycardia discovered at his nursing facility. He is ultimately transferred to a tertiary care facility for consideration of…
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…
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