STEMI / Acute Coronary Syndrome

52M · crushing chest pain · 40 min · radiates to L arm/jaw · diaphoretic · HTN, smoker, FHx MI

Case background

Mr. Youssef, 52, walked into the ED 10 minutes ago. Crushing substernal chest pain began 40 minutes ago while watching television. Pain 9/10, radiating to left arm and jaw. Diaphoretic and nauseous. PMH: hypertension on amlodipine, 30 pack-year smoker. FHx: father died of MI at 58.

Your objective

Identify anterior STEMI on 12-lead ECG and initiate reperfusion pathway within 15 minutes.

Safe to learn. Treat it as real; mistakes here are the material we learn from and never touch a real patient.

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The clock is real

Each phase has its own time. Run out and the patient deteriorates.

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Say how sure you are

Low, medium or high confidence on every action. Confident and wrong costs the most.

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Hazards end the pass

Some options cause harm. One hazard means the case cannot pass.

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Hints cost points

Three levels of help, each costing more.

Pass mark 75% with no hazard · educational simulation, not medical advice

Reviewed against current guidance: 2025 ACC/AHA ACS guideline; 2025 AHA CPR/ECC · Nov 2026