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The electrocardiogram in the ACS patient: high-risk electrocardiographic presentations lacking anatomically oriented ST-segment elevation

#Diagnosis #Cardiology #ECG
The electrocardiogram ... anatomically oriented ST-segment ... elevation #Diagnosis ... #Cardiology #ECG ... #EKG #STEMI #Equivalents
Note there is ST depression in aVR, a true sign of Left Main occlusion.  Many
Note there is ST ... in aVR, a true sign ... is a good ECG sign ... #Clinical #EM #IM ... #STElevations #
Here’s an ECG of a patient with 100% Acute LAD Occlusion

Remember that RBBB normally has ST
RBBB normally has ST ... So ANY ST Elevation ... segment should ... STEMI Criteria misses ... #EKG #Electrocardiogram
Causes of ST Segment Elevation - Differential Diagnosis Framework

STEMI:
 • Upsloping convex STE: "Pardee's sign" +
Diagnosis Framework STEMI ... : "Pardee's sign ... blocking drugs #STElevation ... #ST #STEMI #Segment ... #ekg #electrocardiogram
De Winter T-Waves on EKG
 - Anterior OMI
 - 2% of left anterior descending occlusions
 -
Winter T-Waves on EKG ... before or after STEMI ... elevation in aVR ... segment - ST depression ... #ECG #Electrocardiogram
STEMI Equivalents on ECG
 • Conventional STEMI - Elevation of ST segment at (or 40-60 ms
STEMI - Elevation ... of ST segment at ... transitioning in a convex ST-segment ... indistinguishable from ST-segment ... #EKG #diagnosis
Pericarditis on EKG
Stage 1 - Widespread ST elevation (<5mm) and PR depression; In aVR: ST depression
1 - Widespread ST ... depression; In aVR: ST ... Normalization Spodick's sign ... Downsloping TP segments ... #ECG #electrocardiogram
De Winter T Wave on ECG

Diagnostic Criteria
 - Tall, prominent, symmetric T waves in the precordial
segment depression ... segment elevation ... aVR - “Normal” STEMI ... #EKG #Clinical ... #Electrocardiogram
Approach to ECGs - Ischemia
MI = Biomarkers + ECG or echo/angiogram findings
Pathologic Q - 1/3 height
0.5mm downgoing ST ... Equivalents / Don't Miss Signs ... line; upsloping ST ... #EKG #diagnosis ... #electrocardiogram