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.
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