REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion

Take Home Points

1. Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately.

2. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations.

3. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion. History is important as this can also be seen in other sick patient populations (e.g. Sepsis)

4. De Winters T waves are the earliest sign of an anterior wall MI but will only be present in ~ 2% of LAD infarcts

5. Patients with Wellens Syndrome on ECG should have a cardiac cath within 24 hours, not necessarily within the first 60 minutes of ED arrival.

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