ACS, STEMI, NSTEMI & High-Risk Chest Pain: ECG Patterns, Reperfusion & Board Traps | EM Board Review

Acute coronary syndrome from recognition to reperfusion. STEMI equivalents (Wellens, de Winter, posterior MI, modified Sgarbossa), the HEART score, dosing anchors for aspirin, UFH, and enoxaparin, reperfusion timing goals, and the classic board traps. 📑 Chapters 0:00 Intro 0:03 ACS STEMI NSTEMI & High Risk Chest Pain 0:33 Objectives 1:18 ED Mindset Chest Pain Is a Risk Problem 1:46 ACS Definitions The ED Translation 2:31 Initial ED Chest Pain Algorithm 3:12 ECG First Ten Minutes What You Must Not Miss 3:52 STEMI Criteria & Cath Lab Activation 4:23 ECG Pattern Anterior STEMI 4:55 ECG Pattern Inferior STEMI & RV Concern 5:35 ECG Pattern Posterior MI 6:19 ECG Pattern NSTEMI Myocardial Ischemia 6:53 STEMI Equivalents Wellens & de Winter 7:30 ECG Pattern de Winter T Waves 7:57 LBBB Paced Rhythm Modified Sgarbossa Lens 8:53 STEMI Mimics Do Not Let the Mimic Trap Delay Care 9:53 Hyperkalemia The ACS Mimic That Kills Fast 10:41 ED ACS Medications Dosing Anchors 11:37 STEMI Reperfusion Algorithm 12:27 NSTEMI Unstable Angina ED Management 13:26 HEART Score Risk Stratification 14:18 Antiplatelet & Anticoagulation Strategy 15:10 Nitrates Beta Blockers Oxygen & Pain Control 15:51 Complications Shock Arrest & Mechanical Disasters 16:29 Special Situations 17:06 Disposition Who Leaves Who Stays Who Goes to Cath 17:45 Board Traps Where People Get Burned 18:17 Case 1 Inferior STEMI With RV Involvement 18:57 Case 2 NSTEMI Is Not Low Risk 19:27 Case 3 Posterior MI Hidden in Plain Sight 19:57 Board Question 1 20:20 Board Question 2 20:47 Board Question 3 21:10 Final Takeaways 21:46 References Presented by Ezekiel Shepard, M.D. Shepard MD — high-yield emergency medicine education for board exams, shift performance, and clinical reasoning. ⏱ CHAPTERS 0:00 ACS STEMI NSTEMI and High Risk Chest Pain 0:30 Objectives 1:16 ED Mindset Chest Pain Is a Risk Problem 1:47 ACS Definitions The ED: Translation 2:26 Initial ED: Chest Pain Algorithm 3:10 ECG First Ten Minutes What You Must Not Miss 3:55 STEMI Criteria and Cath Lab Activation 4:29 ECG Pattern Anterior STEMI 5:02 ECG Pattern Inferior STEMI and RV Concern 5:37 ECG Pattern Posterior MI 6:07 ECG Pattern NSTEMI Myocardial Ischemia 6:43 STEMI Equivalents Wellens and de Winter 7:14 ECG Pattern de Winter T Waves 7:43 LBBB Paced Rhythm Modified Sgarbossa Lens 8:29 STEMI Mimics Do Not Let the Mimic Trap Delay Care 9:13 Hyperkalemia The ACS Mimic That Kills Fast 9:50 ED ACS Medications Dosing Anchors 10:47 STEMI Reperfusion Algorithm 11:41 NSTEMI Unstable Angina ED: Management 12:49 HEART Score Risk Stratification 13:43 Antiplatelet and Anticoagulation Strategy 14:23 Nitrates Beta Blockers Oxygen and Pain Control 14:56 Complications Shock Arrest and Mechanical Disasters 15:41 Special Situations 16:20 Disposition Who Leaves Who Stays Who Goes to Cath 17:01 Board Traps Where People Get Burned 17:32 Case 1 Inferior STEMI With RV Involvement 18:16 Case 2 NSTEMI Is Not Low Risk 18:48 Case 3 Posterior MI Hidden in Plain Sight 19:19 Board Question 1 19:46 Board Question 2 20:16 Board Question 3 20:41 Final Takeaways 21:14 References 📚 ABOUT THIS SERIES Shepard MD delivers polished, board-relevant emergency medicine lectures for residents, attendings, and students preparing for boards or trying to sharpen on-shift clinical reasoning. Each lecture covers a focused high-yield topic with specific dosing anchors, treatment-sequence framing, and the classic board traps. 🎓 REFERENCES & ACKNOWLEDGEMENTS Content informed by Rosen's Emergency Medicine (10th edition), Foundations of EM Board Review, and current society guidelines (ACEP, AHA/ACC, SCCM, IDSA, ATLS, and others as relevant per lecture). ECG images: Life in the Fast Lane (LITFL) ECG Library — litfl.com — used with attribution under educational, non-commercial use. ⚠ DISCLAIMER This content is for educational purposes only. It does not replace clinical judgment, institutional protocols, or specialty consultation. Always follow your local guidelines and consult appropriate specialists. 💬 Comment with topics you want covered next. 👍 Like and subscribe for more high-yield emergency medicine board content. #EmergencyMedicine #BoardReview #MedicalEducation #ShepardEMBoardReview