STEMI Equivalent

Occlusion MI: STEMI Criteria & Beyond

Key Points: The ECG’s primary role in ACS is detecting acute coronary occlusion. Acute coronary occlusion myocardial infarction (OMI) is a time-critical diagnosis that requires immediate reperfusion. Time is myocardium….

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…

Traditional STEMI Criteria (Millimetric Thresholds)

Key Points: STAT ECG is the first decision point in ACS. The primary purpose of the initial ECG is to identify patients who meet traditional STEMI criteria and require immediate…

de Winter T Waves: STEMI Equivalent Pattern

Key Points STEMI Equivalent: The de Winter ECG pattern is an uncommon STEMI equivalent indicative of an unstable proximal occlusion of the LAD (left anterior descending coronary artery). Treat the…

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…

Is This a STEMI or STEMI Equivalent Pattern?

A 51-year-old man presents to the emergency department with acute chest pain that has progressively worsened over the past 3 hours. Pain radiates to the jaw and is associated with…

Concerning chest pain with ST segment depression in the anteroseptal leads (Part 2/2)

A 50-year-old woman presents to the emergency department with acute chest pain. The following ECG is obtained on arrival:

Concerning chest pain with ST segment depression in the anteroseptal leads (Part 1/2)

A 72-year-old woman with a past medical history of diabetes, coronary artery disease, and heart failure presents to the emergency department with acute onset chest and back pain.  Pain is…

STAT ECG Diagnoses: must know ECG patterns in screening for acute coronary occlusion

A 58-year-old woman is brought into the emergency department by paramedics with chest pain and diaphoresis. The following EMS ECG was obtained:

ECG Basics & Fundamentals: when to get posterior leads

A 70-year-old man presents to the ED with ischemic chest pain. The following ECG is obtained:

STAT ECG Diagnoses: the most commonly missed STEMI does not have ST segment elevation

A 70-year-old man presents to the ED with radiating chest tightness, nausea, and diaphoresis. The following ECG is obtained:

STAT ECG Diagnoses: ST segment depression in precordial leads

A 52-year-old man with history of hyperlipidemia and smoking presents to the ED with 2 hours of radiating chest pressure associated with diaphoresis and dyspnea. The following ECG is obtained:

Literature Review: De Winter T waves