OMI: STEMI & Beyond
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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…
Three More ECG Pitfalls That Punish Anchoring Bias
A 51-year-old man with lung cancer presents with shortness of breath and tachycardia. The arrival ECG shows an S1Q3 pattern and seems to support a familiar diagnosis that would normally…
Four ECG Pitfalls That Punish Anchoring Bias
A 43-year-old woman with sharp left-sided chest pain and minimal cardiac risk factors has an initial ECG that is not diagnostic for STEMI. She looks stable, but one feature on…
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…
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…
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…
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…
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:
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…
Beyond ST Elevation: Guideline Based Cath Lab Activation
A 61-year-old woman with PMHx of prior MI presents with acute midsternal chest pain that radiates to the left shoulder. Symptoms have been intermittent for the fast few weeks, without…
2025 ECG Competition Answers (Part 1/3)
This week we review the answers to questions 1-5 from the 13th Annual UMEM Residency ECG Competition. Make sure to attempt to answer the questions yourself before watching the video…
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…
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:
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…
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