STEMI equivalents - Revision history

Lisayee25: /* Posterior MI */ changed posterior ekg finding from 1mm to 0.5mm STE

2020-11-05T19:23:08Z

Posterior MI: changed posterior ekg finding from 1mm to 0.5mm STE

← Older revision		Revision as of 19:23, 5 November 2020
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	**V9: Left paraspinal area line along the 5th ICS		**V9: Left paraspinal area line along the 5th ICS
	*Posterior ECG findings		*Posterior ECG findings
	**≥1 mm ST-segment elevation		**≥0.5 mm ST-segment elevation
	[[File:Posterior MI.jpg\|350px]]		[[File:Posterior MI.jpg\|350px]]

Rossdonaldson1: /* See Also */

2019-03-06T05:37:38Z

Rossdonaldson1: /* See Also */

2019-03-06T02:59:16Z

SLuckettG: /* Wellens’ Syndrome */

2019-03-04T22:18:45Z

Wellens’ Syndrome

← Older revision		Revision as of 22:18, 4 March 2019
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	*[[ECG]] findings in absence of chest pain, but with recent cardiac chest pain symptoms		*[[ECG]] findings in absence of chest pain, but with recent cardiac chest pain symptoms
	*Represents critical stenosis of the LAD		*Represents critical stenosis of the LAD
	*~~Not necessarily STEMI equivalent but will require~~ PCI in the next 24-48hr		*Requires PCI in the next 24-48hr (may evolve more rapidly - observe with serial ECGs)
	*12-Lead ECG findings<ref>Rhinehardt J, et al. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002; 20(7):638-43.</ref>		*12-Lead ECG findings<ref>Rhinehardt J, et al. Electrocardiographic manifestations of Wellens' syndrome. Am J Emerg Med. 2002; 20(7):638-43.</ref>
	**Deeply-inverted or biphasic T waves in V2-3		**Deeply-inverted or biphasic T waves in V2-3
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	**Absent precordial Q waves with preserved R waves		**Absent precordial Q waves with preserved R waves
	*Two T wave characteristics:		*Two T wave characteristics:
	**Type A: Biphasic pattern - 25% - Biphasic T-waves ~~(initial + deflection and terminal - deflection)~~		**Type A: Biphasic pattern - 25% - Biphasic T-waves
	**Type B: Inversion pattern - 75% - Deeply inverted and symmetric T-waves		**Type B: Inversion pattern - 75% - Deeply inverted and symmetric T-waves
	[[File:Wellens.jpg\|350px]]		[[File:Wellens.jpg\|350px]]

SLuckettG: /* De Winter’s T Waves */

2019-03-04T22:03:55Z

De Winter’s T Waves

← Older revision		Revision as of 22:03, 4 March 2019
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	===[[De Winter’s T Waves]]===		===[[De Winter’s T Waves]]===
	*~~Suggestive of~~ proximal LAD lesion		*Suggests proximal LAD lesion
	*12-Lead ECG findings<ref>de Winter R, et al. A new ECG sign of proximal LAD occlusion. NEJM. 2008; 359:2071–2073.</ref>		*12-Lead ECG findings<ref>de Winter R, et al. A new ECG sign of proximal LAD occlusion. NEJM. 2008; 359:2071–2073.</ref>
	**Precordial ST-segment depression at the J-point		**Precordial ST-segment depression at the J-point

SLuckettG: /* LMCA Occlusion */

2019-03-04T22:02:05Z

LMCA Occlusion

← Older revision		Revision as of 22:02, 4 March 2019
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	===LMCA Occlusion===		===LMCA Occlusion===
	*Seen with ~~occlusion or near-occlusion of the~~ left main artery<ref>Hennings JR and Fesmire FM. A new electrocardiographic criteria for emergent reperfusion therapy. Am J Emerg Med. 2012; 30(6):994–1000.</ref>		*Seen with left main artery lesion<ref>Hennings JR and Fesmire FM. A new electrocardiographic criteria for emergent reperfusion therapy. Am J Emerg Med. 2012; 30(6):994–1000.</ref>
	*~~Has been~~ reported in ~~occlusion of the~~ proximal ~~left anterior descending artery~~ and severe multivessel coronary artery disease		*Also reported in proximal LAD lesions and severe multivessel coronary artery disease
	*12-Lead ECG findings		*12-Lead ECG findings
	**ST elevation in aVR ≥ 1mm		**ST elevation in aVR ≥ 1mm

SLuckettG: /* Background */

2019-03-04T20:58:59Z

Background

← Older revision		Revision as of 20:58, 4 March 2019
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	==Background==		==Background==
	*~~Standard teaching for~~ STEMI typically ~~has the following criteria~~<ref>ECC Committee, Subcommittees and Task Forces of the American Heart Association.. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care — Part 8: Stabilization of the Patient With Acute Coronary Syndromes. Circulation. 2005. 112 (24_suppl):IV–89–IV–110. 2005.</ref>		*STEMI typically defined by<ref>ECC Committee, Subcommittees and Task Forces of the American Heart Association.. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care — Part 8: Stabilization of the Patient With Acute Coronary Syndromes. Circulation. 2005. 112 (24_suppl):IV–89–IV–110. 2005.</ref>:
	**≥1 mm (0.1 mV) of ST segment elevation in ~~the~~ limb leads		**≥1 mm (0.1 mV) ST segment elevation in limb leads
	**≥ 2 mm elevation in ~~the~~ precordial leads ~~and~~ present in anatomically contiguous leads		**≥ 2 mm ST segment elevation in precordial leads
	*~~There are several~~ variations from the classic STEMI ECG changes ~~that do not fit this definition~~		**Findings present in at least 2 anatomically contiguous leads
			*Several variations from the classic STEMI ECG changes are similarly concerning and considered 'STEMI equivalent'

	==STEMI Equivalents==		==STEMI Equivalents==

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T22:10:33Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 22:10, 30 May 2017
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	**ST elevation ≥5 mm in a lead with downward (discordant) QRS complex - 2 points		**ST elevation ≥5 mm in a lead with downward (discordant) QRS complex - 2 points
	*Smith's modification<ref>Smith, S, et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. 60(6):766-776.</ref>		*Smith's modification<ref>Smith, S, et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. 60(6):766-776.</ref>
	**Changes the 3rd rule of original Sgarbossa's Criteria to be ST depression OR elevation discordant with the QRS complex and with a magnitude of at least 25% of the QRS increases Sn from 52% to 91% at the expense of reducing Sp from 98% to 90%[		**Changes the 3rd rule of original Sgarbossa's Criteria to be ST depression '''OR''' elevation discordant with the QRS complex and with a magnitude of at least 25% of the QRS increases Sn from 52% to 91% at the expense of reducing Sp from 98% to 90%[
	[[File:Sgarbossa.jpg\|350px]]		[[File:Sgarbossa.jpg\|350px]]

Rossdonaldson1: Text replacement - "ECG" to "ECG"

2016-09-09T11:21:35Z

Text replacement - "*ECG" to "*ECG"

← Older revision		Revision as of 11:21, 9 September 2016
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	===[[Wellens’ Syndrome]]===		===[[Wellens’ Syndrome]]===
	*ECG findings in absence of chest pain, but with recent cardiac chest pain symptoms		*[[ECG]] findings in absence of chest pain, but with recent cardiac chest pain symptoms
	*Represents critical stenosis of the LAD		*Represents critical stenosis of the LAD
	*Not necessarily STEMI equivalent but will require PCI in the next 24-48hr		*Not necessarily STEMI equivalent but will require PCI in the next 24-48hr

ClaireLewis: /* New LBBB */

2016-07-13T00:08:56Z

New LBBB

← Older revision		Revision as of 00:08, 13 July 2016
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	===[[LBBB\|New LBBB]]===		===[[LBBB\|New LBBB]]===
	*New LBBB alone is no longer a reason to activate the cath lab<ref>Jain S, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011; 107:1111-1116.</ref>		*New LBBB alone is no longer a reason to activate the cath lab<ref>Jain S, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011; 107:1111-1116.</ref>
	*However, careful ~~w/u~~ for ACS should be taken for symptomatic patients with LBBB		*However, careful workup for ACS should be taken for symptomatic patients with LBBB
	*12-Lead ECG findings		*12-Lead ECG findings
	**QRS > 0.12 in limb leads		**QRS > 0.12 in limb leads

← Older revision		Revision as of 05:37, 6 March 2019
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	==See Also==		==See Also==
	*[[ST-elevation myocardial infarction]]		*[[ST-segment elevation myocardial infarction]]
	*[[Acute Coronary Syndrome (Main)]]		*[[Acute Coronary Syndrome (Main)]]
	*[[Chest pain]]		*[[Chest pain]]

← Older revision		Revision as of 02:59, 6 March 2019
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	==See Also==		==See Also==
	*[[ST-~~Elevation Myocardial Infarction (STEMI)~~]]		*[[ST-elevation myocardial infarction]]
	*[[Acute Coronary Syndrome (Main)]]		*[[Acute Coronary Syndrome (Main)]]
	*[[Chest pain]]		*[[Chest pain]]

STEMI equivalents - Revision history

Lisayee25: /* Posterior MI */ changed posterior ekg finding from 1mm to 0.5mm STE

Rossdonaldson1: /* See Also */

Rossdonaldson1: /* See Also */

SLuckettG: /* Wellens’ Syndrome */

SLuckettG: /* De Winter’s T Waves */

SLuckettG: /* LMCA Occlusion */

SLuckettG: /* Background */

Mholtz: Text replacement - "OR" to "'''OR'''"

Rossdonaldson1: Text replacement - "*ECG" to "*ECG"

ClaireLewis: /* New LBBB */

Rossdonaldson1: Text replacement - "ECG" to "ECG"