ACS-OMI
Results:
STEMI vs Artifact: DDx
Key Points: Not all ST elevation is ischemia. The most common mimics at the point of care are atrial activity riding on the ST segment, motion or lead artifact, early…
Ischemia & Infarction Interpretation
Key Points: The ECG is the fastest bedside tool for detecting acute coronary occlusion and dynamic ischemia, often before troponin changes and sometimes before classic symptoms. Acute coronary syndromes are…
Right Ventricular STEMI: Criteria & Pitfalls
Key Points RV involvement accompanies up to ~40% of inferior STEMIs; isolated RV infarction is uncommon but high-impact when missed. Think RV MI when inferior STEMI is present and you…
Terminal QRS Distortion: OMI Pattern
Key Points: What it is: In V2 or V3, there is no S wave (the R does not descend below the PQ baseline) and no J wave (no notch/slur at…
Pseudonormalization of T Waves
Key Points Definition: Pseudonormalization is the apparent normalization of previously inverted T waves, often signaling reocclusion of a coronary artery that had recently reperfused. Mechanism: During reperfusion, ischemic T wave…
Occlusion MI in Ventricular Paced Rhythms: STEMI Equivalent Pattern
Key Points 1. Paced Rhythms and Acute MI Detection: Ventricular paced rhythms significantly alter ST segment and T wave morphology, complicating acute myocardial infarction (MI) recognition. Accurate ECG interpretation in…
Occlusion MI in Left Bundle Branch Block: STEMI Equivalent Pattern
Key Points LBBB Does Not Exclude Acute Coronary Occlusion: LBBB alters ventricular activation, leading to expected secondary ST/T abnormalities. However, acute occlusion myocardial infarction (OMI) can and must still be…
Modified Sgarbossa Criteria: STEMI Equivalent Pattern
Key Points Wide QRS Rhythms Can Mask OMI: Left bundle branch block (LBBB) and right ventricular (RV)-paced rhythms alter ventricular depolarization, producing expected secondary ST/T changes. However, acute occlusion MI…
Appropriate Discordance
Key Points Definition: Appropriate discordance is a normal repolarization pattern in which the ST segment and T wave are directed opposite to the main QRS vector. It reflects expected changes…
Aslanger Pattern: OMI Pattern
Key Points: STEMI Diagnosis and Contiguous Leads: While current guidelines typically require ST elevation (STE) in at least two contiguous leads for the diagnosis of STEMI, this practice is not…
Precordial Swirl: OMI Pattern
Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…
EMS ECGs in Acute Coronary Syndromes (ACS)
Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…
Subtle ST Segment Elevation: OMI Pattern
Key Points ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…
South African Flag Sign: OMI Pattern
Key Points Pattern Recognition: The South African Flag Sign is characterized by: ST-segment elevation (STE) in leads I, aVL, and V2. ST-segment depression in lead III. Subtle but visually distinctive…
STEMI vs LVH: DDx
Key Points: Left ventricular hypertrophy (LVH) with strain is one of the most common and dangerous STEMI mimics, particularly in the anterior leads, and is a frequent cause of false-positive…
Upright T Waves in V1
Key Point Normal T Wave in V1: The normal ECG typically shows a flat or inverted T-wave in lead V1. Upright T-Wave Abnormality: An upright T-wave in V1 (TV1) should…
Barcelona Criteria: OMI Pattern
Key Point Challenge in LBBB and RV Pacing: Both left bundle branch block (LBBB) and right ventricular (RV) paced rhythms alter ventricular depolarization and repolarization, making recognition of acute myocardial…
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