Approach to ECGs - Ischemia MI = Biomarkers + ECG or echo/angiogram findings Pathologic Q - 1/3 height of QRS in 2 leads or 1 small box wide, can be new/old infarct STEMI - J point STE >0.1 mV in any 2 contiguous leads, except • V2-V3: ≥0.25mV men <40; ≥0.2mV men ≥40; ≥0.15mV women • DDx: Acute STEMI, Aortic dissection, PE, peri/myocarditis (diffuse STE, diffuse PR dep) NSTEMI/UA - 2 contiguous leads of 0.5mm downgoing ST or 1 mm T inversion with big R or R/S>I STEMI Equivalents / Don't Miss Signs of Ischemia - hyperacute T waves - broad, prominent asymmetrical, similar or bigger than QRS - deWinter T waves - starts below isoelectric line; upsloping ST dep and peaked T in precordial leads with STE in avR - Wellen's T - biphasic/deep-symmetric inverted T V2-4 can have no pain - LAD stenosis - U wave inversion - STE avR - proximal LAD or high burden triple vessel disease - ST depression or T wave inversion in avL - early inferior MI - R/S >1 or ST depression in VI-V2 - posterior infarct, get a 15 lead - STE V1 >V2 or STE/isoeIectric in VI with depression in V2 - RV infarct - New tall T wave in V1 - normal T is inverted in V1, unless LBBB/LVH/high voltage - Dr. Michael Wong @mchlwng #Ischemia #ECG #EKG #diagnosis #electrocardiogram #cardiology #STEMI #Equivalents #Interpretation #differential
