ST Elevation
Results:
STEMI in the Presence of Baseline ECG Abnormalities
Key Points: Baseline ECG abnormalities do not protect patients from occlusion MI. They increase miss rates because they distort the ST segment and T waves. The core question is not…
Lateral and High-Lateral STEMI: Criteria, Localization, and Pitfalls
Key Points: Lateral and high-lateral STEMI often present with subtle ST elevation and are commonly missed or labeled as nonspecific ST-T changes. Small-appearing ECG changes may represent true coronary occlusion…
Inferior STEMI: Criteria, RV Involvement, and Pitfalls
Key Points: Inferior STEMI is the most common STEMI subtype and is frequently complicated by right ventricular and posterior involvement. Inferior occlusion may present with classic ST elevation, subtle ischemic…
Anterior STEMI: Criteria, Localization, and Pitfalls
Key Points: Anterior STEMI represents large myocardial territory at risk and carries the highest mortality among STEMI subtypes. Early recognition and reperfusion are critical. LAD occlusion may present with classic…
ST Elevation: DDx
Key Points: ST elevation describes an ECG finding, not a diagnosis. It reflects abnormal ventricular repolarization and can arise from ischemic, structural, metabolic, electrical, or extracardiac processes. Occlusion MI is…
Diffuse ST Elevation: DDx
Key Points: ST-segment elevation (STE) is an ECG finding, not a diagnosis. Multiple ischemic and non-ischemic processes can produce STE. Diffuse STE is often non-ischemic, in contrast to the regional…
STEMI vs Early Repolarization: DDx
Key Points: Early repolarization (ER) is a common, benign ECG pattern that most often appears in young, healthy patients. It can closely resemble acute anterior STEMI, creating a high-risk diagnostic…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points: Pattern, not a STEMI equivalent. ST elevation in aVR (≥1 mm), often with ST elevation in V1 and diffuse ST depression (≥1 mm in ≥6 leads), represents high-risk…
ST Elevation in aVR: DDx
Key Points: ST elevation (STE) in aVR with diffuse ST depression elsewhere most often reflects global subendocardial ischemia, not focal transmural infarction. High-risk coronary disease is one cause, not the…
Early Repolarization
Key Points: Historical View: Early repolarization (ER) was long considered a benign cause of ST elevation, often called benign early repolarization (BER). Modern View: Certain ER patterns, now termed malignant…
Osborn (J) Wave: Basics
Key Points An Osborn wave is a notch or slur at the J point that becomes more prominent as core temperature falls. Most visible in inferolateral and precordial leads; can…
Isoelectric Segment of the ECG
Key Points The reference for ST-segment shift is the J point relative to an isoelectric baseline. The two candidates for that baseline are the TP segment and the PR segment….
Right Axis Deviation + ST Elevation: DDx
Key Points RAD combined with ST-segment elevation (STE) is an uncommon but high-risk finding. While STE often suggests acute coronary occlusion, this pattern rarely reflects classic STEMI. Several non-ischemic conditions…
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…
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;…
When ST Elevation Isn’t What It Seems
A 30-year-old man with a history of coronary artery disease and heart failure with reduced ejection fraction (HFrEF) presents to the emergency department with acute chest pain and shortness of…
Interesting Cases from UMMC (2024 – Part II/III)
A 58-year-old man presents to the emergency department with acute chest pain and shortness of breath. The following ECG is obtained:
Differential Diagnoses: ST segment elevation and short QTc interval
A 40-year-old male is brought into the ED with vomiting, body aches, chest discomfort and fatigue. The following ECG is obtained:
STAT ECG Diagnoses: STEMI mimics and how you can use the QRS axis to clinch the diagnosis in patients with altered mental status
A 46-year-old man presented with pleuritic left sided chest pain. He was found down for an unknown period of time, with suspicion for drug overdose. The following ECG was obtained:
EMS ECGs: opportunity to save lives prehospital by recognizing severe hyperkalemia
A 69-year-old man presents to the emergency department with palpitations. He is otherwise well. The following ECG is obtained:
ECG Tags
- A-Z
- ACS-OMI
- Advanced Level Curriculum
- Annual ECG Competition
- Anterior OMI
- Anterior STEMI
- Approach
- Arrest
- Arrhythmia
- Artifact
- Attending
- AV Block
- aVF
- aVL
- aVR
- Axis
- Board Review
- Bradyarrhythmia
- Chest Pain
- Clumped Beats
- Conduction
- Core
- Core Level Curriculum
- Curriculum
- DDx
- Devices
- Diagonal Branch Occlusion
- Diffuse ST Elevation
- Documentation
- Early Repolarization
- ECG Interpretation
- ECG Localization
- ECG Variant
- Education/Teaching
- Electrolytes
- Emergencies
- Emergent Cath Lab Activation
- EMS
- Expert Level Curriculum
- Foundations Level Curriculum
- Guidelines
- High-Lateral STEMI
- Hub
- Hyperacute T waves
- Hypercalcemia
- Hyperkalemia
- Hypermagnesemia
- Hypocalcemia
- Hypokalemia
- Hyponatremia
- Hypothermia
- I
- II
- Index
- Inferior OMI
- Inferior STEMI
- Intervals
- Irregular
- Ischemia
- Ischemia & Infarction
- J Waves
- LAD Occlusion
- Lateral STEMI
- LBBB
- LCx Occlusion
- Lead Placement
- LV an
- LV Aneurysm
- Mastery Level Curriculum
- Metabolic
- Mimics
- Narrow QRS
- Occlusion MI
- OMI Pattern
- Osborn Waves
- P Wave
- Paced Rhythms
- Pacemaker/ICD
- Paramedics
- Pauses
- PE
- Pediatrics
- Pericardial
- Pericarditis
- PGY-1
- PGY-2
- PGY-3
- PGY-4
- Post-Cardiac Arrest
- Posterior Extension
- Posterior MI
- Posterior STEMI
- PR
- Preexcitation
- Premature Complexes
- Prolonged QT
- Pulmonary Embolism
- Pulse-Tapping Artifact
- PVCs
- Q Wave
- QRS
- QT
- R Waves
- RAD
- RBBB
- RCA Occlusion
- Regular
- Reperfusion
- Rhythm
- S Waves
- Segments
- Seizure
- Serial ECGs
- Shock
- ST
- ST Depression
- ST Elevation
- STEMI
- STEMI Equivalent
- STEMI Mimics
- STEMI Negative OMI
- Stroke
- Structural
- Students
- Syncope
- T Waves
- Tachyarrhythmia
- Tachycardia
- Tamponade
- Terminal QRS Distortion
- Toxicology
- TP
- Traditional STEMI Criteria
- U Waves
- Unstable
- V1-V4
- V5
- V6
- Ventricular Rhythms
- Ventricular Tachycardia
- Voltage
- Waveforms
- Wide QRS
- WPW
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