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Here’s an ECG of a patient with 100% Acute LAD Occlusion

Remember that RBBB normally has ST
Remember that RBBB ... So ANY ST Elevation ... have ’relative elevation ... STEMI Criteria misses ... #EKG #Electrocardiogram
Approach to ECGs - Ischemia
MI = Biomarkers + ECG or echo/angiogram findings
Pathologic Q - 1/3 height
, Aortic dissection ... Equivalents / Don't Miss Signs ... in V1, unless LBBB ... #EKG #diagnosis ... #electrocardiogram
Causes of ST Segment Elevation - Differential Diagnosis Framework

STEMI:
 • Upsloping convex STE: "Pardee's sign" +
: "Pardee's sign ... morphology similar to LBBB ... • Acute aortic dissection ... #ST #STEMI #Segment ... #ekg #electrocardiogram
Modified Sgarbossa Criteria - Diagnostic Checklist for diagnosing MI in LBBB or Pacemaker
1) Identify LBBB or
Discordance" = ST ... waves in opposite direction ... Criteria - Suspect STEMI ... Diagnosis #Checklist #EKG ... #electrocardiogram
STEMI Equivalents on ECG
 • Conventional STEMI - Elevation of ST segment at (or 40-60 ms
STEMI - Elevation ... V2 • Wellens sign ... pain • Wellens sign ... #EKG #diagnosis ... differential #cardiology #electrocardiogram
Modified Sgarbossa Criteria for diagnosing STEMI in the presence of a LBBB If there is concordant
for diagnosing STEMI ... presence of a LBBB ... in the same direction ... elevation of greater ... Modified #Criteria #LBBB