Compendium of ECG findings concerning for ☠️♥️occlusive MI ♥️☠️ (1/11)
First, back to basics & traditional STEMI criteria! Here's a nice figure of Lead Anatomy. I saved this forever ago, so not exactly sure of the source ¯\_(ツ)_/¯
(2/11)
STEMI criteria is met if: STE at least 1mm in 2 contiguous leads, but with higher cut-offs in V2-V3, & with addition of new LBBB in setting of compatible clinical picture. You can localize the coronary lesion using the leads affected! Localization chart by @DrEricStrong (3/11)
Before going into "STEMI equivalents" (better phrasing: "occlusive MI amenable to revascularization"), here's a figure from @LITFLblog on the J-point, which will be referenced later in the thread!
Occlusive MI: hqmeded-ecg.blogspot.com/2018/04/the-om…
J-point: litfl.com/j-point-ecg-li…
(4/11)
OK, here is ♥️De Winter's T Waves♥️, concerning for proximal LAD lesion! Great thread on this pattern here:
(5/11)
Next, ♥️Wellens' Syndrome♥️, a clinical syndrome characterized by biphasic or deeply inverted T waves plus a history of recent chest pain now resolved. The progressive T wave changes can be understood as follows: litfl.com/wellens-syndro…
(6/11)
Speaking of anterior MIs, a higher level concept that should be more widespread involves ☠️Terminal QRS Distortion☠️, defined as the absence of S-wave & J-wave in either V2/V3. Such distortion suggests Subtle Anterior MIs! @smithECGBlog
hqmeded-ecg.blogspot.com/2022/02/this-e…
(7/11)
♥️ First Diagonal Occlusion ♥️ presents with a fun pattern called the South African Flag Sign! An easy way to remember this is the upper leads (on ECG strip, not anatomical leads) have upward changes (STE & upright T waves), while lower leads have downward changes.
(8/11)
More on D1 occlusion here:
(9/11)
♥️ Posterior MI ♥️: horizontal STD in V1-V3 & upright T waves in V1-V3.
However, STD maximum in V1-V4 can also be due to subendocardial ischemia (not occlusive MI) when there is tachycardia, especially if due to AFib with RVR.
See: hqmeded-ecg.blogspot.com/2021/11/is-thi…
(10/11)
Fin! Corrections appreciated! I'M A LOWLY INTERN & AM NOT PRETENDING TO KNOW 50% OF THIS IN DETAIL!
However, if you are trying to up your ECG game, follow: @smithECGBlog @EM_RESUS. For basics to advanced, check @DrEricStrong's Youtube series.
(11/11)
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