STEMI Equivalents

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STEMI Equivalents

Hyperacute T Waves

  • in ≥ 2 contiguous leads

  • broad and asymmetric

  • concerning when upright T-wave in V1 > V6

  • also need to rule out hyperK

Wellen's Waves

  • Commonly in V/2/V3

  • Type A: biphasic T waves

  • Type B: more common; deep, symmetric T waves inversions

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AVR

  • ST Elevation >1mm in AVR and/or V1 with diffuse depressions

  • LMCA occlusion, LAD occlusion, or triple vessel disease

    • Nonspecific, can also see this EKG with PE, aortic dissection, etc.

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De Winter’s T Waves

  • ST depression with peaked T Waves

    • > 1 mm of upsloping ST depression and tall symmetric T-waves commonly in the precordial leads

  • Proximal LAD occlusion

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Also consider:


Posterior MI

  • ST depressions in V1-V3

  • Get posterior EKG with leads V7V8V9

    • STE ≥ 0.5 mm (≥ 1 mm in men < 40 years) in V7, V8, or V9

  • Left circumflex or RCA occlusion

Right Ventricular MI

  • should consider in your inferior STEMI pts

  • ST elevation in V1 (+/- V2 ST elevation OR depression)

  • ST elevation in lead III > lead II

  • Get a right sided EKG with leads V3V4V5

    • Can have elevations in these

  • RCA occlusion

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