ST elevation gets all the attention when discussing EKGs. We have special STEMI and C-port alerts making it particularly sexy. Everyone knows to look for STEMI and how to manage it (aspirin, +/- Plavix load and straight to cath lab).

However, we cannot forget about other important critical EKG findings that manifest themselves with ST depression and T wave abnormalities. These are the cases that will bite you in the @$$ if you miss them. Below are EKG entities that you should look for on your next EKG and may make you consider talking to Cardiology sooner than later.

Important ST and t wave changes that mandate your attention:

1.    posterior mi

Anterior ST depressions along with dominant R waves in V1-V3 concerning for Posterior STEMI

2.    Wellens-A-original

Deep inverted or biphasic T waves in V2-V3 concerning for Wellens’ Syndrome (critical stenosis of the LAD)

3.    hyperacute

Upsloping ST depressions with symmetrically peaked T waves in the precordial leads which represent Hyperacute T waves concerning for LAD occlusion

4.    LMCA

Diffuse ST depressions with elevation in aVR concerning for Left Main Occlusion