Electrocardiography (ECG) is an emergency department staple, and tremendous advances in diagnosis have been made recently. But can you spot the extremely subtle pattern differences that could mean the difference between admission and discharge, or life and death?

Amal Mattu, MD, FACEP

Amal Mattu, MD, FACEP, professor and chair at the University of Maryland School of Medicine in Baltimore, is an expert in spotting these ECG subtleties and backing them up with the most current literature. His lecture “From Paper to Patient: Recent Advances in Emergency Electrocardiography That Will Save a Life” will cover some of these tricky reads:

• Left bundle branch block pattern: “Diagnosing an acute MI [myocardial infarction] in the presence of this confounding pattern can throw off a physician’s ability to diagnose a heart attack,” said Dr. Mattu. “There has been literature to help us clarify diagnosis—it isn’t necessarily well known to some of the cardiologists out there, but should be known to everyone who works in an ER.”
• Early repolarization: As a benign variant, Dr. Mattu said that there’s been a host of discussion as to whether early repolarization is truly benign or not. “It’s easy to mistake an ECG diagnosis of a true STEMI for early repolarization,” he said.
• ECG patterns of patient athletes: If a young athlete with chest pain shows abnormal patterns, should you worry? Maybe, or maybe not, said Dr. Mattu. “Athletes develop changes in their heart that can cause ECG patterns that mimic having ischemia or a heart attack, when really it’s a completely normal finding in people who are extremely well-conditioned.”

Amy E. Hamaker is a Canyon Country, California-based freelance writer.