Dr. Smith's ECG Blog: Resources

OMI Manifesto
About
Resources
Teaching Images
Lectures + Podcasts
Rules + Equations
OMI Literature Timeline
OMI Facts and References
The OMI Quizzes
OMI Pocket Guide
Cardiac CATH Guide
QTc Calculator
Lead Reversals-Artifact
Neuroprotective CPR
OMI AI: The Queen of Hearts

Resources

Protocols:

Abbott High Sensitivity Troponin Algorithm at Hennepin Healthcare

Books:

Dr. Smith's Book: The ECG in Acute MI

Doug Brunette's Great Book: Extraordinary Cases in Emergency Medicine

Dr. Wang's Atlas of EKG - the best

Great Ultrasound Textbook, Reardon on Echocardiography

Critical Decisions in Acute Care electrocardiography -- ACS section by Dr. Smith

Websites:

Life in the Fast Lane Best ECG Resources

This site tests your rhythm interpretation skills: https://monitortech.org/rhythm-strip-practice.html

Pierre Taboulet's Great French ECG site

ECG Medical Training

Life in the Fast Lane ECG library

EMS 12-Lead

Ken Grauer's excellent EKG site

EM Crit

hqmeded.com

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About Dr. Smith

Dr. Stephen W. Smith is a faculty physician in the Emergency Medicine Residency at Hennepin County Medical Center (HCMC) in Minneapolis, MN, and Professor of Emergency Medicine at the University of Minnesota.

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Dr. Smith Articles on PubMed

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Disclaimer

Cases come from all over the world. Patient identifiers have been redacted or patient consent has been obtained. The contents of this site have not been reviewed nor approved by Hennepin County Medical Center and any views or opinions expressed herein do not necessarily reflect the views or opinions of Hennepin County Medical Center.

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I highly recommend using this blog as an atlas or textbook. Use the "label" below the archive (below) to search for all kinds of ECG cases, with discussion.

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Labels (Index)

"No reciprocal changes" (1)
"inferior" ST depression (12)
(Occlusion Myocardial Infarction) (6)
10 cases examples of lateral hyperacute T-waves V4-V6 (2)
10 in each location (1)
15-lead ECG (2)
1st degree heart block (1)
2:1 AV Block (2)
2nd degree AV block Mobitz II (3)
3-Vessel disease (1)
ACC Guidelines violated (2)
AIVR (9)
ARVC (2)
ARVD (3)
AV block (17)
AV block - pathophysiology (1)
AV dissociation (13)
AVNRT AV nodal re-entrant tachycardia (4)
AVRT Antidromic (3)
AVRT: AV Reciprocating Tachycardia (through accessory pathway) (5)
Aberrant conduction (3)
Accelerated AV conduction (2)
Acidosis (2)
Adenosine (8)
Adjunctive Anti-Ischemic Therapy (2)
Alcohol binge (1)
Anatomic (1)
Angiogram case (4)
Angiography in ROSC shockable rhythms (3)
Anomolous coronary artery (1)
Anterior STEMI with minimal ST elevation less than 1 mm (11)
Anti-dysrhythmics in STEMI w cardiac arrest/ventricular fibrillation (2)
Antiplatelet Therapy for UA/NonSTEMI (1)
Aortic Dissection (7)
Apical takotsubo (1)
Appropriate Discordance in LBBB and Paced Rhythm (1)
Arrhythmogenic Right Ventricular Cardiomyopathy (4)
Arrhythmogenic Right ventricular dysplasia (3)
Aslanger pattern (4)
Atrial Fibrillation RVR due to Secondary condition (2)
Atrial Fibrillation with RVR (5)
Atrial Fibrillation with RVR exaggerates ST Elevation (1)
Atrial Flutter that is Very Slow (2)
Atrial Repolarization Wave with Additional Ischemic ST Depression (1)
Atrial Septal Defect (2)
Atrial Tachycardia (6)
Atrial enlargement and hypertrophy (2)
Atrial fibrillation-conversion to sinus (1)
Atropine (2)
Atypical Symptoms (5)
Autopsy (1)
BRASH (3)
Back to Basics cases (1)
Barcelona Rule for LBBB (1)
Benign (2)
Benign T-wave Inversion (21)
Benign T-wave Inversion -- Countless Examples (1)
Benign T-wave Inversion that is dynamic (1)
Benign T-wave inversion with prominent U-wave (1)
Beta Adrenergic Blockade (5)
Bifascicular block (4)
Bifid T waves (1)
Biphasic T waves (1)
Brugada induced by fever (4)
Brugada pattern (10)
CNS (1)
CNS T-waves (1)
COACT (3)
COVID (2)
CPR (1)
CT Coronary Angiogram (CTCA) (6)
CT scan (12)
Cabrera's sign (4)
Calcium Therapy for Hyperkalemia (5)
Cardiac arrest -- emergent angiogram indications (2)
Catecholaminergic Polymorphic VT (1)
Central Nervous System T-waves (1)
Chapman's sign (3)
Chest Pain Resolution (2)
Child (4)
Children (5)
Co-culprit lesions (2)
Cocaine (4)
Comparison posts (2)
Comparison with Previous ECG (2)
Completed Infarction (2)
Concealed conduction in WPW and accessory pathways (8)
Convex ST Elevation (1)
Coronary Artery Bypass (CABG) surgery (2)
Coronary artery dissection (1)
Crochetage sign (2)
Delayed Activation Wave (3)
Delayed Diagnosis of OMI (2)
Diagonal branch (D1 or D2) (8)
Diaphragmatic Hernia (1)
Diffuse ST Depression (18)
Domed T-wave (1)
Downsloping ST Elevation (1)
Dr. K. Wang (20)
Dressler's syndrome (2)
Drug Effect (2)
Dual AV nodal pathways (5)
Dynamic T-waves (10)
ECG Radiologist (1)
ECG misdiagnosis (2)
ECLS -- Extracorporeal Life Support (1)
ECMO -- Extracorporeal Membrane Oxygenation (3)
EMS voltage cutoff (2)
EP study (1)
ESRD (1)
Early Intervention for NonSTEMI (2)
Early Repol Inferior and Lateral (1)
Early Repolarization with Dynamic T-waves (2)
Echo-Bedside-False-Negative (2)
Echo-formal-false negative (3)
Ectopic atrial pacemaker (5)
Electrolytes (1)
Embolus Coronary (2)
Emery phenomenon (3)
Emre Aslanger Posts (3)
Enhanced atrioventricular nodal conduction (EAVNC) (1)
Equation for Early Repol vs. Anterior STEMI (12)
Examples of Formula Use--12 of them (1)
Examples of Hyperacute T-waves (6)
Examples of hyperacute T-waves in V2 -- 10 of them (1)
Excessively discordant ST elevation (5)
False Cath Lab Cancellation (2)
False STEMI-NonSTEMI Dichotomy (2)
False positive ECG (21)
First Degree AV block (4)
Formula - Simplified Alternative (1)
Formula -- Simplified (2)
Formula False Negative (LAD-early repol) (2)
Formula for Early Repol vs. Anterior STEMI (39)
Formula sensitivity and specificity curves (1)
GERD (reflux) diagnosis (4)
Giant R-wave (2)
Group beating (1)
Guidelines violated (3)
Gunshot to heart (1)
HEART score (8)
HOCM (1)
Head Up CPR (1)
Heart Failure--Severe (1)
Heart block (5)
Hemopericardium (1)
High Sensitivity Troponin (11)
High Sensitivity Troponin Algorithm (2)
Hyperacute T-waves -- 30 Example Cases -- 10 in each location (2)
Hyperacute T-waves LAD (21)
Hyperacute T-waves Mimic - Reciprocal (2)
Hyperacute T-waves Missed (2)
Hyperacute T-waves in Paced Rhythm (1)
Hyperacute T-waves--Subtle (4)
Hyperkalemia - NOT (1)
Hyperkalemia PseudoSTEMI cases (4)
Hyperkalemia T-waves -- Small (3)
Hyperkalemia with STE in V1 and V2 (1)
Hypertrophic Cardiomyopathy (9)
Hypocalcemia with hyperkalemia (1)
Hypokalemia -- many good cases in one post (1)
Hypokalemia -- replenishment (1)
Hypokalemia with paralysis (1)
Ibutilide (2)
Infarct Artery (1)
Inferior Aneurysm Morphology (7)
Inferior MI subtle (31)
Inferior OMI Subtle (10)
Inferior STEMI mimic (1)
Inferior de Winter's (2)
Instant Wave Free Ratio (1)
Interpolated PVCs (1)
Intraventricular conduction delay (2)
Invasive vs. Conservative Therapy for Acute MI (1)
Inverted U-wave (2)
Isolated Right Ventricular STEMI (2)
J-point (3)
J-waves (6)
LAD OMI missed (17)
LAD occlusion (102)
LAD occlusion vs. benign early repolarization (43)
LAD reperfusion (13)
LBBB (53)
LBBB OMI (4)
LPFB) (1)
LV aneurysm (35)
LV aneurysm anterior (6)
LV aneurysm inferior (3)
LV aneurysm lateral (1)
LVH (40)
LVH PseudoOMI (5)
LVH Review (2)
LVH T-wave inversion (1)
LVH and LAD formula (2)
LVH and OMI (13)
LVH mimics Precordial Swirl (3)
LVH mimics Wellens (3)
LVH that mimics LAD OMI (2)
LVH vs. OMI (3)
LVH vs. inferior MI (1)
LVH with massive STE (1)
LVH with scary repolarization (1)
Ladder Diagram (5)
Latent Accessory pathway (2)
Lead V1 (1)
Lectures (2)
Left Main Arizona study (1)
Left Main Total Occlusion -- TIMI-0 (3)
Left Posterior Fascicular Block (hemiblock (1)
Lewis Lead (8)
Long QT not measured correctly by computer (9)
Long QT vs. Hyperacute T-waves (1)
Low Voltage (3)
Lown-Ganong-Levine (1)
Lyme carditis (1)
MINOCA (9)
MRI (1)
McConnell’s Sign (1)
Micro-reentrant atrial tachycardia (1)
Mid anterolateral MI (3)
Missed OMI sent home (2)
Mitral Stenosis (1)
Morphine (11)
Multifocal Atrial Tachycardia (MAT) (1)
Myocardial Contusion - NOT! (4)
Myocardial Injury - Chronic (1)
Myocarditis (19)
NOT-pseudonormalization (3)
NSTEMI (5)
NSTEMI is worthless term (1)
Negative U-wave (1)
New LBBB (12)
New sign of LAD occlusion (1)
No Reflow (10)
Non-Occlusion MI (NOMI) (1)
NonSTEMI (7)
Noncompaction cardiomyopathy (1)
Norepinephrine (1)
Normal ECG by computer algorithm (54)
Normal ECG in OMI (3)
Normal Intervals (1)
Normal Previous Angiogram (1)
OMI (142)
OMI Concept posts (1)
OMI Diagnosed by Troponin (2)
OMI Journal Articles (2)
OMI Manifesto (2)
OMI Mimic (9)
OMI Progression (1)
OMI in LBBB (3)
OMI in paced rhythm (4)
OMI signified by AV block (1)
OMI with initial negative troponin (5)
OMI without diagnostic ECG (2)
Occlusion MI/Non-Occlusion MI (OMI/NOMI) paradigm (7)
Occlusion with less than 1mm ST Elevation (11)
Opioids in ACS (2)
P-wave morphology (1)
P-waves inverted (1)
P2Y12 inhibitors (ticagrelor (1)
PE vs. Wellens (1)
PEA - Pulseless Electrical Activity (1)
PERFECT study (3)
PM Cardio Queen of Hearts (58)
PR depression (1)
PR interval (2)
PVC (15)
Pancreatitis (1)
Panic attack (1)
Papillary muscle (mitral valve) rupture (2)
Paradox: No False Negative (1)
Patent Foramen Ovale (1)
Peaked T waves (6)
Pediatric (15)
Persistent Juvenile T-waves (3)
Pleomorphic Ventricular Tachycardia (1)
Polymorphic Ventricular Tachycardia (11)
Posterior OMI-small R-wave-flat ST (1)
Posterior STEMI vs. Subendocardial ischemia (2)
Pre-excitation (1)
Precordial Swirl due to Pulmonary Embolism (1)
Precordial swirl (29)
Premature Atrial Beats (Contractions - PACs - PABs) (1)
Pretest Probability (4)
Previous ECG (4)
Procainamide (5)
Proximal LAD (10)
Proximal RCA culprit (2)
PseudoOMI (5)
PseudoSTEMI (35)
PseudoWellens (6)
PseudoWellens - Reversible - due to Unstable Angina (2)
Pseudoanteroseptal MI (4)
Pseudonormalization of ST segments (3)
QOH (11)
QRS prolongation (2)
QRST angle (2)
QRST axis (1)
QS-waves (6)
QT correction in bundle branch block (1)
QTc (7)
QTc rule of thumb (2)
QU-interval (2)
Queen (4)
Queen false negatives (1)
Queen knows false positive (9)
Queen of Hearts Explainability Images (6)
Queen of Hearts vs. conventional algorithm (2)
Queen sees OMI that I do not (1)
Quiz posts (7)
R-on-T phenomenon (1)
R-wave: reverse progression (1)
RA/LA reversal (2)
RBBB (48)
RBBB and LAFB chronic (1)
RBBB and LAFB in LAD OMI (5)
RBBB pseudoOMI (1)
RBBB with Fascicular Block (1)
RBBB with LAD OMI - findings are often not classic (2)
RBBB with LAFB (Left Anterior Fascicular Block) (20)
RBBB with LPFB (Left Posterior Fascicular Block) (3)
RBBB with LV Aneurysm (1)
RBBB with Pericarditis (1)
RBBB with STE in I and aVL (3)
RBBB with STE in V1-V3 (3)
RBBB with dynamic T-waves (1)
RBBB with excessively discordant STD (2)
RBBB with hyperkalemia (1)
RBBB with posterior OMI (2)
RBBB--Simple (1)
RIght Bundle Branch Block (4)
RSR' (1)
RV Conduction Delay (1)
RV MI (19)
RV dysplasia (1)
RVH (13)
RVMI in lead V1 (10)
RVOT (right ventricular outflow tract ventricular tachycardia) (5)
Ramus Intermedius (1)
Rant post (1)
Reciprocal ST Depression absent -- this is common (1)
Replenishment of K in Hypokalemia (1)
Resolving STE in LBBB (2)
Retrograde P-waves (4)
Reverse Takotsubo Stress Cardiomyopathy (2)
Reversion of dysrhythmia after cardioversion (1)
Right Ventricular Hypertrophy (9)
Risks and risk factors for lytics/PCI (1)
SCAD (4)
ST Depression Maximal V2-V4 due to subendocardial ischemia (2)
ST Depression downsloping (1)
ST Depression in LBBB (1)
ST Elevation -- Non-ischemic (2)
ST Elevation with Tachycardia (1)
ST Segment Monitoring (1)
ST depression (40)
ST depression V5 and V6 (1)
ST depression does not Localize to the ischemic wall (6)
ST depression maximal in V1-V4 (6)
ST elevation (10)
ST resolution (1)
ST segment morphology (1)
ST/S ratio (1)
STD maximal V1-V4 due to Atrial fibrillation (1)
STDmaxV1-4 (11)
STDmaxV5-6 (1)
STE aVL (1)
STE in single lead (1)
STEMI (6)
STEMI vs. NonSTEMI (7)
STEMI with less than 1 mm ST elevation (9)
STEMI-equivalent (2)
STEMI/NonSTEMI paradigm (1)
SVT (1)
SVT with aberrancy (11)
SVT-NOT (1)
Saddleback (1)
Saddleback STEMI (3)
Sasaki rule (1)
Septal STEMI (9)
Septal STEMI - NOT (2)
Shock (2)
Sine Wave (6)
Sinoventricular Rhythm (5)
Sinoventricular rhythm of hyperkalemia (2)
Sinus Pause/Sinus Arrest (1)
Sinus Tachycardia Extreme (2)
Sodium Channel Blockade (7)
Spasm (7)
Speckle Tracking Strain Echocardiography (11)
Spiked Helmet Sign (3)
Spontaneous conversion (1)
Stenosis without thrombosis (1)
Stress Test (8)
Subtle Circumflex Occlusion (2)
Subtle Circumflex Occlusion--Huge OMI (1)
Subtle Inferoposterior Occlusion (1)
Subtle LAD (49)
Subtle LAD Occlusion (53)
Subtle STE (14)
Superimposed: Acute on old MI (1)
Supraventricular Tachycardia (PSVT) (13)
Supraventricular Tachycardia - Not AVNRT (1)
Synchronized Cardioversion (1)
Syncope (33)
T Wave alternans (1)
T wave inversion (5)
T-Wave inversion (21)
T-wave V1 larger than T-wave V6 (2)
T-wave inversion -- diffuse (1)
T-wave inversion evolution (2)
T-wave memory (2)
T-wave: down-up in inferior leads (1)
TEE (transesophageal echo) (2)
TIMI myocardial perfusion grading (1)
Tachycardia-induced cardiomyopathy (1)
Third (3rd) degree AV block (13)
Thrombolytics (11)
Thrombus propagation (1)
Time Window for Reperfusion Therapy (1)
Torsades Management (2)
Toxicology (7)
Tpeak to Tend (1)
Transfer for PCI (1)
Transient OMI (12)
Transient ST Depression STD (1)
Triage ECG (3)
Triage Occlusion (2)
Tricyclic antidepressant (3)
Trifascicular block (5)
Triple vessel disease (1)
Troponin Plateau (1)
Troponin in Type I MI and in OMI (1)
Type 2 Brugada (4)
Type II STEMI (12)
Type_III_wraparound_LAD (10)
U-wave (1)
U-wave inverted (1)
U-waves (23)
Unstable Angina LAD OMI (1)
Unstable Angina in the era of High sensitivity troponin (5)
Unstable angina with 100% Occlusion (1)
Up-Down T-waves (2)
V1-up-V6-down (1)
V1: high R/S ratio or large R-wave in V1 (1)
V2 normal variant TWI with U-wave (1)
VT vs SVT with aberrancy (1)
Valvular disorder (2)
Ventricular Fibrillation (12)
Ventricular Tachycardia due to Hyperkalemia (5)
Ventricular Tachycardia without structural cardiac abnormality (2)
Ventricular Tachycardia--NOT (1)
Viability Study (MRI (1)
Video of RV MI missed by angiogram (1)
WPW (11)
WPW Intermittent (1)
WPW mimicking ischemia (6)
Wavy pattern of hypokalemia (1)
Weakness (1)
Wellens -- inferior-lateral-posterior walls (1)
Wellens in LBBB (2)
Wellens waves - probable (1)
Wellens with 100% LAD but some collateral circ (1)
Wellens' Syndrome - NOT!! (5)
Wellens' classic evolution (3)
Wellens' in Paced Rhythm (1)
Wellens' in inferior or lateral leads ("reperfusion T-waves") (6)
Wellens' syndrome (31)
Wide complex tachycardia (41)
Widespread ST Elevation (2)
Young Women (16)
aVL (30)
aVL importance in inferior OMI diagnosis (5)
aVL/I only (1)
aVL: true + vs. false + ST Elevation (2)
aVR (30)
aVR - large R-wave (2)
ablation (1)
accelerated idioventricular rhythm (9)
accelerated junctional rhythm (3)
aconite (1)
acute right heart strain (9)
acuteness (8)
african american/black (1)
algorithm (5)
alkalosis (2)
alternating BBB (2)
anaphylaxis (1)
anterior STEMI equation (14)
anterior T wave inversion (15)
aortic stenosis (4)
arterial pulse tapping artifact (9)
artifact (9)
asthma (1)
atrial fibrillation (5)
atrial fibrillation with RVR - primary instability (1)
atrial fibrillation with WPW (7)
atrial fibrillation with slow ventricular response (1)
atrial flutter (27)
atrial flutter mimicking ischemia (2)
atrial flutter with 1:1 conduction (6)
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