DSAE STEMI Review: Classic Patterns of the STEMI Cpy

Let us review a series of classic STEMI patterns with a review of the salient features of each.  Let us specify the absence of the LVH or LBBB.  With that exclusion, the following is a true statement:

ST-segment elevation concave down in the associated leads with ST-segment depression in the reciprocal leads is virtually diagnostic of the ST-elevation MI (STEMI).

Clinical Pearl:  

When evaluating the patient with acute coronary syndrome (ACS), if you do not see significant changes on the 1st cardiogram, you should consider serial ECGs every 10 – 15 minutes apart.  If it is a STEMI, you will eventually see evolutionary changes of the P-PR-segment and QRS-ST-T complexes.

If it is a non-ischemia/non-infarction patient, you will note a stable unchanging ECG, i.e. serial tracings will aid you in deciding that the observed changes represent infarction/ischemia OR are a mimic such as benign normal variant (early repolarization), LVH with ST-T changes, LBBB with Primary or Secondary ST-T changes, pericarditis, etc.  We will address these mimics in a later topic section.

Let us begin by examining one of the most common STEMIs you will encounter:  THE ACUTE INFERIOR STEMI.