REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion

Marco Torres on 07/05/2023

Take Home Points

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.
POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations.
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)
De Winters T waves are the earliest sign of an anterior wall MI but will only be present in ~ 2% of LAD infarcts
Patients with Wellens Syndrome on ECG should have a cardiac cath within 24 hours, not necessarily within the first 60 minutes of ED arrival.

Take Home Points

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.
POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations.
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)
De Winters T waves are the earliest sign of an anterior wall MI but will only be present in ~ 2% of LAD infarcts
Patients with Wellens Syndrome on ECG should have a cardiac cath within 24 hours, not necessarily within the first 60 minutes of ED arrival.