Approach to ECGs

Recent University of Maryland Medical Center Cases (Part I)

A 67-year-old man presents to the emergency department with chest pain and palpitations. The following ECG is obtained on arrival:

Optical Illusions and 12-Lead ECGs: How First Impressions Can Mislead

A 42-year-old woman presents to the emergency department with chest pain, shortness of breath, and palpitations. Her blood pressure and mental status are noted to be normal. The following ECG…

Unrecognized Killers in Emergency Electrocardiography, Part III

A 55-year-old woman with a history of hypertension, diabetes, and tobacco use presents to the emergency department with chest heaviness and shortness of breath. Her initial ECG raised immediate concern…

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:

2025 EMS Cases Part I

A 55-year-old woman calls EMS with acute palpitations and chest discomfort. Vitals are normal aside from marked tachycardia. The following prehospital ECG is obtained:

2025 In-Training Exam Preparation (Part III/III)

A 47-year-old male presents to the emergency department with acute chest and back pain. The following ECG is obtained, and concerning for diffuse ST segment elevation:

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…

The Approach to Uncovering Hidden STEMI

A 92-year-old man presents to the emergency department with acute chest pain and diaphoresis. The following ECG is obtained:

A Key Question That Clinches the Diagnosis

A 54-year-old man presents to the emergency department with nausea, vomiting, and lightheadedness. The following ECG is obtained:

AI Advances in ECG Interpretation: Why Human Expertise Still Matters

Navigating a Very Abnormal QRS Axis with a Stepwise Approach

A 44-year-old woman presents to the emergency department with vague complaints about shortness of breath. The following ECG is obtained at triage and brought to you for interpretation:

Avoiding Misdiagnosis Through Proper Lead Placement

A 40-year-old man with no known medical problems presents with concerns about his cardiac health after a friend recently had an MI. He has no symptoms of acute coronary syndrome…

Key Points to Note About Complete Heart Block

A 70-year-old woman presents to the emergency department with lightheadedness and dizziness that is worse with standing. The following ECG is obtained:

Key Points to Note About Mobitz I & Mobitz II

A 49-year-old man presents to the emergency department after an episode of syncope. The following ECG is obtained:

Concerning chest pain with ST segment depression in the anteroseptal leads (Part 1/2)

A 72-year-old woman with a past medical history of diabetes, coronary artery disease, and heart failure presents to the emergency department with acute onset chest and back pain.  Pain is…

Shock first and ask questions later?

An elderly woman with a past medical history of hypertension, diabetes, and Parkinson’s disease presents to the ED with hip pain after a fall. Her blood pressure and mental status…

2024 ECG Competition Answers (Part 2/2)

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…

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…

Sloof Lirpa Sign

A 65-year-old woman presents to the emergency department with an episode of near-syncope. Her ECG shown below is interpreted by the ECG machine, an emergency physician, and a cardiologist as…