OMI & STEMI Mimics

UMMC Cases Part I: Three ECGs That Reward a Second Look

A 62-year-old man presents with chest pain during a busy emergency department shift. His triage ECG is interpreted by the computer as showing ST-segment depression and possible ischemia. The tracing…

A Closer Look at the J Point

A 72-year-old man undergoes a prehospital 12-lead ECG. The tracing appears to show ST segment elevation in leads III, aVF, and aVR, raising concern for an inferior STEMI or high-risk…

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…

Three High Risk ECGs and the Right Next Move

A 34 year old man presents with acute chest pain radiating to the left arm associated with diaphoresis. He has hyperlipidemia and a family history of early coronary disease. The…

The Cath Lab Was Activated, But Something Didn’t Fit

A 70-year-old woman with CHF, COPD, intermittent atrial fibrillation, chronic pain medication use, and recent poor intake develops sudden dyspnea at rest and is found somnolent and bradycardic in the…

UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not

A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the…

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…

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…

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:

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:

2024 UMMC Cases (Part I)

A 69-year-old man arrives at the emergency department with shortness of breath and profuse sweating. The ECG obtained below shows sinus tachycardia at a rate of ~ 130 bpm with…

When One Lead Stands Alone: Deciphering Bizarre ECG Abnormalities

A 67-year-old woman with PMHx of HTN, DM, and ESRD presents to the emergency department drowsy and non-cooperative. Her blood sugar is elevated, pH 7.23, and there is concern for…

Cardiovascular Effects of Cannabis Use

A 32-year-old woman presents to the emergency department with gradually worsening chest pain throughout the day. She has no significant medical history and no known cardiac risk factors. She reports…

AI Advances in ECG Interpretation: Why Human Expertise Still Matters

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…

When ST Elevation Isn’t What It Seems

A 30-year-old man with a history of coronary artery disease and heart failure with reduced ejection fraction (HFrEF) presents to the emergency department with acute chest pain and shortness of…

2024 ECG Competition Answers (Part 1/2)

Instructions from Dr. Mattu: In some of the following questions, I’ll ask you for a FULL ECG interpretation/diagnosis. Here’s what I am asking for: SAMPLE QUESTION: A 58 yo M…

Literature Review: Fever and ST segment elevation after syncope

A young woman presents to the ED after a syncopal episode. She hit her chest after falling and has reproducible chest wall tenderness on exam. She is also noted to…

Literature Review: ST segment elevation after syncope and cardiac arrest

A 22-year-old man with no known significant PMHx presents after syncope. He is asymptomatic on arrival with normal vital signs. History and physical exam is non-diagnostic. While an ECG is…

Do these biphasic T waves and ST segment abnormalities suggest acute coronary occlusion MI?

A 40-year-old man is brought to the emergency department for acute chest pain. The following ECG was obtained: