Not quite a STEMI


    Not quite a STEMI

    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



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