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•Each year, 785,000 Americans will have a new coronary event.•The diagnosis of ST-elevation myocardial infarction is essential to appropriate triage and timely intervention.•The 12-lead ECG is the “gold standard” for clinical decision-making for evaluation of patients with chest pain.•Changes in the ECG indicating a STEMI include hyperacute T waves and convex ST-elevation in contiguous leads.•The...