STEMI Equivalents on ECG • Conventional STEMI - Elevation of ST segment at (or 40-60 ms after) the J point • De Winter syndrome - J-point depression and upsloping ST depression in V1-V6 that continues into tall, positive symmetrical T-waves, often with 1-2 mm ST elevation in aVR • Posterior STEMI - ST depression ≥ 0.05 mV (horizontal or downsloping and concave) in V1-V3 (or V4) especially if there is a tall R in V1/V2 with R/S ratio > 1 in V2 • Wellens sign A - Biphasic anterior T waves, not always accompanied by chest pain • Wellens sign B - Deeply inverted anterior T waves, not always accompanied by chest pain • Hyperacute T wave - Tall, often asymmetrical, broad-based anterior T-waves often associated with reciprocal ST depression • Sgarbossa criterion 1 - ST elevation ≥ 0.1 mV concordant to the QRS in any of the leads l, aVL, V4 to V6 • Sgarbossa criterion 2 - ST depression ≥ 0.1 mV concordant to the QRS in any of the leads V1 to V3. • Sgarbossa criterion 3 (modified) - ST elevation with amplitude >25% of the depth of the preceding S-wave with discordant QRS complex (leads V1 to V3) • "Shark fin" - J-point transitioning in a convex ST-segment (T wave indistinguishable from ST-segment due to extreme ST deviation) • Acute ischemia in LVH - ST elevation >25% of QRS amplitude AND (ST elevation in 3 contiguous leads, or T-wave inversions in the anterior leads) #STEMI #Equivalents #ECG #EKG #diagnosis #differential #cardiology #electrocardiogram
