Spoon Feed
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.

Source
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.

Spoon Feed
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.

Source
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.

Spoon Feed
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.

Source
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.

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

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

Source
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.

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

Spoon Feed 
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. 

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

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

Spoon Feed
Massive ST segment elevation on ECG (so called 'shark fin' pattern, see below) is indicative of severe myocardial injury and is associated with increased risk of ventricular arrhythmia, cardiogenic shock, and death.

Spoon Feed
This study suggests that high-dose nitroglycerin infusion may be a safe alternative to intermittent bolus dosing for SCAPE, but prospective trials are needed to determine optimal initial rates and titration strategies, as well as the proper use of other adjunct therapies.

Source
High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2022 Oct 18;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub ahead of print.