Thread by @ASanchez_PS

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:

https://twitter.com/Dr_DanMD/status/1189943795141332993?s=20

(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:

https://twitter.com/EM_RESUS/status/1456651746894393348?s=20&t=iReflbmpI05GObK-jlC4wQ

(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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