Thread by @novitskiynic

1. “STEMI equivalent” #ECG patterns is crucial for every👨🏻‍⚕️👩🏻‍⚕️ dealing with #ACS.
-in 10-25% pts for urgent #PCI
📍Wellens’ syndrome
📍de Winter sign
📍hyperacute T waves,
📍left bundle branch block (LBBB)
📍right bundle branch block (RBBB)

📎ajconline.org/article/S0002-…

2.📍Wellen’s syndrome📍
(other names Wellens' sign, Wellens' warning, Wellens' waves):
is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD)

3.📍de Winter sign📍
-ECG abnormality described by de Winter et al. in 1998
-Characterized by 1-3 mm of ST-depression with upright, symmetrical T-waves
-Suspicious for proximal occlusion of the LAD
-Recognized as a STEMI equivalent by Rokos et al. in 2010

4.📍Hyperacute T waves📍
Broad, asymmetrically peaked or ‘hyperacute’ T-waves are seen in the early stages of ST-elevation MI (STEMI) and often precede the appearance of ST elevation and Q waves.

They are also seen with Prinzmetal angina

5.📍Left bundle branch block📍
QRS duration of>120 ms
Dominant S wave in V1
Broad monophasic R wave in lateral leads(I,aVL,V5-V6)
Absence of Q waves in lateral leads (I, V5-V6; small Q waves are still allowed in aVL)
Prolonged R wave peak time>60ms in left precordial leads(V5-6)

6.📍Right bundle branch block📍
-Broad QRS > 120 ms;
-RSR’ pattern in V1-3 (‘M-shaped’ QRS complex);
-Wide, slurred S wave in the lateral leads (I, aVL, V5-6);