DSAE STEMI Review, Mod 4: Tracings # 6-10


Tracing 6:  STEMI?

This tracing exhibits:

  • Peaked T-waves and ST elevation in leads V1, V2, V3, V4
  • |QRS| > 0.12 sec
  • Lead I all upright
  • RSR’ slur or notch Lead I, II, III, avL, avF, V5, V6

Summary:  This tracing represents a classic LBBB with Secondary T-wave changes.

No. This tracing is not a STEMI.


Tracing 7:  STEMI?

This tracing exhibits:

  • ST Depression: V3-V6, I, II, avL
  • ST Elevation: V1, slight in III
  • Peaked Ts in V1, V2; T-wave inversion/biphasic V4-V6, I, avL

Summary: LVH with ST-T changes; Axis approximates -30 degrees; IVCD

No.  This tracing does not represent a STEMI.

Tracing 8a and 8b (new and old ECGs, respectively)


8b…Old for Comparison

Tracings 8a & 8b:  STEMI?

We note the following from the tracings above:

  • Tall peaked T-waves
  • diffuse ST elevations (concave up)
  • PR segment depression noted
  • Lead avR changes?………….PR-segment elevation, ST-segment depression

Summary:   Acute Pericarditis (the differential must include the possibility of developing hyperacute Ts , Hyperkalemia).

No, this tracing does not represent a STEMI.  This patient should be very closely monitored with serial ECGs, labs, cardiology consult, echocardiogram, hospital admission, etc………………as always, the patient care is dictated by clinical correlation.


Tracing 9:  STEMI?

This tracing exhibits:

  • Significant Qs Lead III, avF, V1, V2; Peaked Ts
  • |QRS| > 0.12 sec
  • Lead I upright with slur (notch)
  • RSR'(notched) noted V6

Summary:  LBBB with Secondary T-wave changes, Left Axis, Late Transition – Pseudoischemia patterns secondary to the LBBB.

No.  This tracing does not represent an acute STEMI.


Tracing 10:  STEMI?

This tracing exhibits:

  • Tiny Rs or Qs Leads V1 to V5
  • Broad, symmetrical,smooth peaked, tall T-waves in the Antero-lateral-highlateral leads and ST-elevations.
  • ST downsloping and biphasic Ts in Lead  III, avF
  • Of note is the absence of LVH and LBBB

Summary:  Hyperacute T-waves and ST elevations of Acute Antero-Lateral-highlateral MI (STEMI)

Yes.  This tracing represents an acute STEMI.

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