ST Elevation
Results:
ST Elevation: DDx
Key Points Definition: ST elevation refers to upward displacement of the ST segment above baseline, often signaling acute myocardial injury. Clinical Importance: While most concerning for STEMI due to acute…
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…
ST Elevation in aVR: DDx
Key Points Global Subendocardial Ischemia: ST elevation (STE) in aVR with diffuse ST depression elsewhere usually reflects global subendocardial ischemia. Proximal Occlusion or Severe CAD: Common in left main (LMCA)…
Diffuse ST Elevation: DDx
Key Points ST-Segment Elevation (STE): It’s crucial to recognize that several conditions beyond STEMI can cause ST-segment elevation (STE) on an ECG. Identifying these differentials is vital to avoid misdiagnosis…
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…
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…
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…
ST Elevation in aVR with Diffuse ST Segment Depression: OMI Pattern
Key Points Pattern: ST elevation in aVR (≥1 mm), often with ST elevation in V1 and widespread ST depression (≥1 mm in ≥6 leads). Mechanism: Reflects global subendocardial ischemia, often…
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;…
Early Repolarization vs STEMI: DDx
Key Points Differentiation Challenge: Early repolarization (ER) is a benign ECG pattern often seen in healthy young individuals, characterized by ST segment elevation that can mimic STEMI and acute pericarditis….
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:
Literature Review: 2018 STEMI & STEMI equivalent guideline updates (Part 2/3)
A 60-year-old woman presents to the ED with midsternal chest pain concerning for an acute coronary syndrome. The following ECG is obtained:
Literature Review: 2018 STEMI & STEMI equivalent guideline updates (Part 1/3)
A 50-year-old man presents to the ED with midsternal chest pain concerning for an acute coronary syndrome. The following ECG is obtained:
Differential Diagnoses: diffuse ST segment elevation with a focus on left ventricular (LV) aneurysm
HPI: An elderly gentleman presents to the ED with diarrhea. He has no chest pain or dyspnea, and denies nausea or vomiting. He appears well. The following ECG was obtained…
Differential DIagnoses: tall R wave in lead V1
An 80-year-old man is brought in by ambulance to the ED for chest pain and dyspnea. He looks sick on exam and is found to be hypotensive, tachycardic, and tachypneic….
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