STEMI and equivalent

STEMI patterns

View a larger version of this infographic

  1. Conventional STEMI

    ST-segment elevation at the J point in two contiguous ECG leads

    • In V2-3 :
      • = 0.2 mV in men > 40 years
      • = 0.25 mV in men < 40 years
      • = 0.15 mV in women in V2-3
    • In other leads > 0.1 mV for both sexes
  2. Hyperacute T waves

    Hyperacute T waves: are tall, often asymmetrical, broad-based anterior T waves often associated with reciprocal ST depression.

  3. De Winter ST-T complex

    De Winter ST-T complex is a ST-segment depression at the J point with ascending ST segment and tall, symmetrical T-waves in the precordial leads, often combined with a 1–2mm elevation of the ST-segment in aVR.

  4. Sgarbossa criteria

    Left bundle branch block or pacemaker rythm with concordant or = 5mm ST elevation. See also (Simplified Sgarbossa criteria)

  5. Wellens

    CAVE: These ECG patterns are not always yet accompanied by chest pain and usually precede overt ST elevation myocardial infarction. They can be interpreted as an early sign of impending coronary occlusion (within 24 hours).

    • Type A: Deeply-inverted anterior T waves
    • Type B: Biphasic anterior T waves
  6. Left Ventricular Hypertrophy

    ST elevation in presence of left ventricular hypertrophy can be tricky to interpret. ST elevation > 25% of QRS amplitude AND [presence of STE in 3 contiguous leads OR presence of T-wave inversions in the anterior leads] is strongly suggestive of acute myocardial infarction.

  7. Posterior STEMI

    0.05 mV ST depression in V1-3 especially associated with positive T wave (0.05 mV elevation in V7-9)

  8. Shark T

    J-point depression transitioning in a convex ST segment

  9. Diffuse ST depression

    AVR/V1 = 0.1 mV + 8 leads with ST depression = 0.1 mV is moderately suggestive of left main coronary artery occlusion.

  10. Persistent pain

    Persistent pain despite medical treatment, especially in presence of RBBB or pacemaker rhythm should be regarded as a possible coronary occlusion in absence of a clear alternative explanation

  11. Now you are ready to take the Mini ECG Quiz!