• Alexander Bracey, H Pendell Meyers, and Stephen W Smith.
• Albany Medical Center, Department of Emergency Medicine, Albany, NY, USA. Electronic address: braceya@amc.edu.
• Am J Emerg Med. 2021 Jul 1; 45: 683.e5-683.e7.

AbstractA 72-year-old man presented to the ED following witnessed cardiac arrest. After return of spontaneous circulation, an ECG was performed which demonstrated a wide complex rhythm with "shark fin" morphology. With careful examination it is possible to identify the J point and determine that the electrocardiogram (ECG) findings actually represent massive ST-elevation indicative of occlusion myocardial infarction (OMI). Initial troponin was undetectable. The patient underwent emergent cardiac catheterization and had a 100% proximal LAD occlusion that was successfully stented. The patient was discharged home neurologically intact several days later. This case highlights the importance of careful ECG interpretation and the limitations of troponin assays in the evaluation of acute coronary syndrome. Most importantly, we demonstrate how to evaluate for ST elevation in the context of a widened QRS complex.Copyright © 2020 Elsevier Inc. All rights reserved.

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