DSAE STEMI Review, Mod 4: Tracings #1-5

Please review the following ECGs to determine presence or absence of the STEMI:


Tracing 1: STEMI?

This tracing represents a classic LBBB.  It exhibits STEMI mimic features as follows:

  • Pseudoinfarction pattern ST-elevation and Q-waves in V1, V2, V3
  • Secondary T-wave changes

Otherwise, No.  This tracing does not represent a STEMI


Tracing 2:  STEMI?

This tracing does exhibit ST elevation diffusely throughout.  However this represents ST-elevation of early repolarization (benign normal variant).

No. This tracing does not represent a STEMI.


Tracing 3: STEMI?

Of note in this tracing:

  • RSR’ in V1, V2, V3
  • |QRS| > 0.12 sec
  • Lead I biphasic with a broad terminal S-wave

Therefore, this tracing represents a classic RBBB with Secondary T-wave changes.  An LAFB is also present.

No. This tracing does not represent a STEMI.



Tracing 4: STEMI?

Please note the ST-segment of lead V4R is elevated and further that it is concave down.  This is what we would expect to find in the setting of an acute MI in a lead directly looking at that particular myocardial section.

Please recall, in the setting of the Acute Inferior MI, you should “think” acute Right Ventricular MI and proceed to look for it.  (The same may be said of the Acute Posterior MI.)

  • Of note is the absence of LVH and LBBB

YES.  This tracing represents an Acute Right Ventricular and Inferior  STEMI.


Tracing 5:  STEMI?

This tracing exhibits the following findings:

  • There is no evidence of LVH or LBBB
  • The intervals are Normal.
  • There is Left Axis Deviation Present
  • There are ST elevations in Leads V2 through V6 and avL, I (Maximum 5 mm) and biphasic T-waves in Leads II, III avF.

Summary:  ST elevations in Leads, V2, V3, V4, V5, V6, I and avL with concave down curvature.  Reciprocal ST depression in Leads II, III, avF.

YES.  This tracing represents an Acute Antero-Lateral-Highlateral MI (STEMI).

Now, please click “MARK COMPLETE” or “NEXT”.