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Presented is a discussion of ECG and clinical findings in the setting of a ventricular paced rhythm (and other wide QRS complex rhythms) that could signal the presence of occlusion myocardial infarction (OMI).

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In patients with ROSC after OHCA, these 'STEMI equivalents' do not appear to accurately diagnose ACS based on this study. 

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Previous guidelines suggested that isolated aVR elevation with multi-lead ST depression could be considered as a STEMI equivalent. However, current evidence suggests aVR elevation is not specific for an acute coronary event.

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Does ST Elevation in Lead aVR Require an Emergent Trip to the Catheterization Laboratory? JAMA Intern Med. 2023 Mar 1;183(3):261-262. doi: 10.1001/jamainternmed.2022.5901.

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Hyperacute T-waves are best conceptualized as being tall and wide relative to the size of the QRS complex, as well as abnormally symmetric, and can be used to aid in early identification of an acute coronary occlusion.

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Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. Ann Emerg Med. 2023 Mar 3:S0196-0644(23)00025-2. doi: 10.1016/j.annemergmed.2023.01.011. Epub ahead of print.

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In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.

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Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.

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Early identification and treatment of thoracic aortic dissection is paramount to patient survival and good clinical outcomes. Here's what you need to know.

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Hyperacute T-waves, when defined by an absolute amplitude threshold greater than the 95^th percentile, were not helpful in diagnosing myocardial infarction.

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Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. 2023 Feb 9:S0196-0644(22)01327-0. doi: 10.1016/j.annemergmed.2022.12.003. Epub ahead of print.

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New evidence has demonstrated that previous dogma to withhold nitrates from patients with right ventricular myocardial infarction (RVMI) may be incorrect.

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High sensitivity cardiac troponins (hs-cTn) can be more complex to interpret than our usual diagnostics and are worth a deep dive to understand. This article does an incredible job summarizing existing guidelines and data about how to utilize hs-cTn clinically. 

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Patients with STEMI or STEMI equivalent who were treated within goal treatment times had significantly lower in-hospital mortality.

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Treatment time and In-Hospital Mortality Among Patients with ST-Segment Elevation Myocardial Infarction, 2018-2021. JAMA. 2022 Nov 22; 328(20): 2033-2040.