ECG cases is a monthly blog by Jesse McLaren (@ECGcases), a Toronto emergency physician with an interest in emergency cardiology quality improvement and education. Each post features a number of ECGs related to a particular theme or diagnosis (with a focus on acute coronary occlusion), so you can test your interpretation skills. We challenge you with missed or delayed diagnosis, those with false positive diagnosis, and those that had a rapid and correct diagnosis. Cases are followed by a quick summary of the literature that relates to the cases, and we bring it home with practice changing pearls that you can use on your next shift.

ECG Cases 44 ECG Interpretation in Epigastric pain, Vomiting

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations. We consider electrolyte disturbances and look for ECG signs of hyperkalemia or hypokalemia/hypomagnesemia, and we consider the differential of diffuse ST depression with reciprocal ST elevation in aVR, and false positive STEMI...

By |2023-08-08T22:28:20-04:00August 8th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , , , |2 Comments
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ECG Cases 43 – ECG Interpretation in Shortness of Breath

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR. For RV strain, acute vs chronic, we should look for signs of acute RV strain and chronic pulmonary hypertension. for low voltages we should consider pericardial effusion and other causes, and for hyperkalemia we should look for multiple signs of hyperkalemia as a guide for empiric calcium...

By |2023-06-06T09:45:16-04:00June 6th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , , |0 Comments
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ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life...

By |2023-05-12T13:36:17-04:00May 10th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , , , |0 Comments
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ECG Cases 41 – STEMI, Occlusion MI Complications

How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? Dr. Jesse McLaren reviews the complications of MI through 10 ECG cases and how they alter management...

By |2023-05-05T08:37:51-04:00April 11th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , |2 Comments
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ECG Cases 40 – Approach to Spontaneous Coronary Artery Dissection (SCAD)

Dr. Jesse McLaren on when to consider Spontaneous Coronary Artery Dissection (SCAD), which patients are at risk for reocclusion, and the challenges of diagnosing SCAD in patients who have nonischemic ECGs despite silent occlusion, occlusions perfused by collaterals, or from non-occlusive MI on this ECG Cases...

By |2023-02-28T10:58:37-05:00February 28th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , |4 Comments
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ECG Cases 39 – Transient STEMI Pitfalls and Pearls

In this ECG Cases blog we look at 9 patients with possible transient STEMI and discuss pitfalls and pearls in ECG interpretation and management...

By |2023-01-17T09:26:01-05:00January 17th, 2023|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , |0 Comments
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ECG Cases 38 – ECG Interpretation in Cocaine Chest Pain

Dr. Jesse McLaren discusses some key aspects of cocaine chest pain ECG interpretation in this month's blog including: Patients with cocaine-associated chest pain require benzodiazepines +/- nitroglycerine for symptom relief, aspirin and ECG to look for signs of occlusion and reperfusion. In patients with chest pain + ST elevation, consider false positive STEMI including early repolarization, LVH and Brugada-pattern. In patients with cocaine chest pain who are STEMI negative, beware STEMI(-)OMI including subtle ST elevation, hyperacute T waves, reciprocal change, and refractory ischemia. For cocaine chest pain patients who's chest pain has resolved, look for reperfusion T wave inversion, as this may put them at risk for reocclusion.

By |2022-12-20T10:59:50-05:00December 20th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , |0 Comments
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ECG Cases 37 ECG interpretation in electrolyte emergencies

While most of us have a clear algorithm in our minds for the management of life-threatening hyperkalemia, the same may not be said about the other life-threatening electrolyte abnormalities. In this ECG Cases blog Dr. Jesse MacLaren gives us an approach to potassium, calcium and magnesium abnormalities including risk factor assessment, ECG interpretation and management pearls...

By |2022-11-08T11:53:30-05:00November 8th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, Medical Specialty|Tags: , , , , , , , , |1 Comment
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ECG Cases 36 – PACER Mnemonic for Approach to Pacemaker Patients

In this month's ECG Cases blog Dr. McLaren explains the PACER mnemonic approach to patients with pacemakers: Pacemaker spike: is it appropriately presence/absent, is there pacemaker-mediated tachycardia (apply magnet) or is there failure to pace (apply magnet to stop sensing, cardio consult)? Aware (sensing): is it normal, is there oversensing (underpacing: apply magnet) or undersensing (treat reversible causes, cardio consult). Capture: if there are pacemaker spikes is there capture, or failure to capture (treat reversible causes, cardio consult). ECG 12 lead: are there signs of hyperkalemia (extra wide QRS, peaked T) or Occlusion MI (Modified Sgarbossa Criteria) that need immediate treatment. Rest of patient: is there a complication of pacemaker insertion related to the pocket (hematoma, infection), lead (pneumothorax, DVT), or heart (pericardial perforation), or is there an emergency unrelated to the pacemaker (eg dehydration, sepsis, GI bleed)...

By |2022-10-11T11:25:43-04:00October 11th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, Medical Specialty|Tags: , , , |0 Comments
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ECG Cases 35 – ECG Approach to Takotsubo Syndrome

Takotsubo Syndrome is usually triggered by an emotional or physical stress leading to acute catecholaminergic myocardial stunning. The initial ST elevation phase of Takotsubo Syndrome mimics Occlusion MI, can not be distinguished by patient factors or POCUS findings, and requires immediate angiogram. The subsequent phase of Takotsubo Syndrome has T wave inversion in an apical distribution, which can mimic reperfusion, but often has very deep T wave inversions and a very long QT interval. Takotsubo Syndrome is a retrospective diagnosis of exclusion—with an angiogram ruling out occlusion, a ventriculogram showing apical ballooning, and a follow up echo showing recovery of LV function. Complications of Takotsubo Syndrome include LV failure, apical thrombus, and polymorphic VT from long QT. Jesse McLaren guides us through 10 ECGs to elucidate these important take home points...

By |2022-09-13T10:51:58-04:00September 13th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , |0 Comments
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