DSAE STEMI Review, Mod 4: Tracings #21-25

Tracing 21

Tracing 21:  STEMI?

We observe the following from the above tracing:

  • |QRS| > 0.12 sec
  • RSR’ Lead V6
  • Peaked Ts and ST elevation V1 → V6
  • Lead I all upright with notch or slur

Summary:  LBBB with Secondary T-wave changes

No. This tracing is not an Acute STEMI.

Tracing 22.a. & 22.b.

22.a. (Hour 0)

22.b. (Hour 1)

Tracings 22a and 22b:  STEMI?

From the above tracings we observe:

At time “o hours” the T-waves are noted to be low voltage and asymmetrical as we would expect to see on a “normal” ECG.  This tracing does meet the criteria for LVH.

At time “1 hour”, the T-waves have become peaked, symmetrical, broad based.

The patient is presenting with ACS symptoms.

Yes.  These tracings represent an evolving STEMI.

Tracing 23

Tracing 23:  STEMI?

In the above tracing we observe:

  • |QRS| > 0.10 sec
  • PR < 0.12 sec
  • Presence of Delta waves
  • Significant Q-waves V1, III, avF

Summary:  The triad criteria for the WPW pattern is present.  Distortion by the WPW manifests as seen in V1, III, avF with the presence of significant Q-waves. This is probably a pseudoinfarction pattern.

No.  This is not an Acute STEMI.

Tracing 24

Tracing 24: STEMI?

We observe the following from the above tracing:

  • ST elevation: I, avL, V1 → V6
  • ST depression: III, avF
  • Hyperacute T-waves and ST elevation Leads V1→V6, I, avL
  • Of note is the absence of LVH and LBBB

Summary: ST-elevation of the Hyperacute T-wave of the AnterolateralHighlateral MI.

Yes.  This tracing is an Acute AnterolateralHighlateral  STEMI.

Tracing 25



Tracing 25: STEMI

First let us look at all the Leads with a particular focus on Lead III and note the following:

  1. This tracing meets the criteria for LBBB
  2. Applying theModified Sgarbossa Criteria:
  • The terminal portion of the QRS complex is positive.
  • The J-point is elevated > 1mm →→→→This is a Concordant ST elevation→→→
  • This is a STEMI


Yes. This is an Acute STEMI and an LBBB.