Not every acute coronary occlusion announces itself with an obvious textbook STEMI.

Sometimes the changes are subtle. Sometimes the tracing does not meet traditional STEMI criteria. Sometimes the first 12 lead looks almost reassuring, while the patient's history, symptoms, and evolving ECG tell a very different story.

For EMS clinicians, those details matter.

Following the foundational ECG concepts introduced in Episode 1, The Heartbeat Series returns for Episode 2: STEMI or Not? “The Subtle Clues that Matter.”

Dr. Muhammad Shareef will take prehospital clinicians beyond basic STEMI recognition and into the more difficult territory where clinical judgment, serial ECGs, reciprocal changes, evolving patterns, and the patient's overall presentation become essential.

Our Speaker

Muhammad Shareef, MD, is an emergency physician at UW Health SwedishAmerican Hospital in Rockford, Illinois, where he serves in several leadership roles, including Vice Chair, Associate Medical Director, EMS Medical Director, and Emergency Medicine Clerkship Director.

His work connects emergency department care, EMS medical direction, and clinical education, giving him a practical perspective on the decisions that matter before, during, and after patient arrival.

About This Session

A 12 lead ECG is only one piece of the clinical picture.

A patient may have ongoing myocardial ischemia or acute coronary occlusion without dramatic ST elevation. Changes may be limited to a few leads, appear as reciprocal findings, evolve during transport, or become meaningful only when interpreted alongside the patient's symptoms and presentation.

The challenge for the prehospital clinician is knowing when the ECG deserves another look.

This session will explore the subtle clues that should raise concern for acute coronary occlusion, including changes that may fall outside classic STEMI criteria. Participants will examine how serial ECG acquisition, reciprocal changes, clinical presentation, coronary anatomy, and communication with the receiving facility can influence recognition and activation decisions.

The goal is not to turn every unusual ECG into a STEMI alert.

The goal is to recognize when the tracing and the patient do not fit neatly into a computer generated interpretation or a single set of measurements, and when those findings should change what happens next.

For EMS, early recognition can influence destination decisions, hospital activation, treatment priorities, and ultimately the time between coronary occlusion and definitive reperfusion.

Join us for another practical, field focused conversation designed to strengthen ECG interpretation, clinical judgment, and confidence when the answer is not immediately obvious.

General Learning Objectives

Upon completion of this activity, participants will be able to:

• Differentiate classic STEMI findings from subtle or evolving ECG patterns that may indicate acute coronary occlusion despite not meeting traditional STEMI criteria.

• Identify reciprocal changes, dynamic ST segment and T wave abnormalities, and other ECG findings that should increase suspicion for acute myocardial ischemia or coronary occlusion.

• Integrate the patient's symptoms, clinical presentation, serial 12 lead ECG findings, and coronary vessel distribution when evaluating suspected acute coronary syndrome.

• Determine when subtle, atypical, or evolving ECG findings warrant repeat ECG acquisition, early communication with the receiving facility, or escalation within the local STEMI system of care.

Emergency Education Night Webinar Series Goal

The overall goal of the Emergency Education Night Webinar Series is to strengthen clinical judgment, communication, and system coordination among emergency and prehospital providers through evidence informed education that supports high risk and time sensitive patient encounters.

Target Audience

This activity is designed for:

• Emergency Medical Responders (EMR)
• Emergency Medical Technicians (EMT)
• Advanced Emergency Medical Technicians (AEMT)
• Paramedics
• Critical Care Paramedics
• Emergency department nurses
• Advanced practice providers
• Physicians
• Other healthcare professionals involved in emergency response and patient care across the prehospital and emergency department settings

CAPCE Accreditation Statement

This activity is accredited by the Commission on Accreditation for Prehospital Continuing Education (CAPCE) for 1.0 continuing education hour (CEH).

• CAPCE Basic CEH
• CAPCE Advanced CEH

Participants must attend the live session in its entirety and complete the required attendance verification and evaluation to receive continuing education credit.

Granting of CAPCE credit does not represent endorsement by CAPCE or its board members.

Cost

There is no cost to attend this activity.

To register for the live session, follow the link: The Heartbeat Series Episode 2: STEMI or Not? “The Subtle Clues that Matter”