Background: Therefore, electrocardiogram (ECG) findings can identify occlusion myocardial infarction (OMI) sooner and more accurately for emergent reperfusion The aim of this work was to identify the degree of familiarity of Egyptian emergency physicians with different levels of training and experience with atypical ECG patterns associated with OMI not meeting classic ST elevation myocardial infarction (MI) criteria. Methods: This cross-sectional survey screening study was carried out on 301 physicians dealing with patients presenting by chest pain in particular Emergency physicians, specialities, both sexes, with varying levels of experience and post-graduate clinical training: Bachelor's degree, Master's degree, Egyptian fellowship, Arab Board, and Medical doctorate. Main bulk of our survey questionnaire included 10 ECG patterns, classified into 4 main groups. All participants subjected to: questionnaire generated using Google form was anonymous. Results: Graduates of Yemeni medical school scored less than their Egyptian counterparts (P= 0.03). However, all other nationalities didn't show any differences. A cardiologist scored 0.91 higher than an emergency medicine physician (P < 0.01). However, all other specialities scored the same as the emergency medicine physician. A physician with a medical doctorate scored higher than MBBCH (P < 0.01). Conclusions: Our study showed results like other published international studies as regards the difficult interpreting ECGs. Cardiologists with long years of experience and/or candidates who had medical doctorate degree were the most who truly recognized the ECG patterns with OMI.