STEMI MIMICS/EQUIVALENTs ECG Flashcards
STEMI equivalents (require EMERGENCY PCI)
Hyperacute T waves
Isolated posterior MI
Left main coronary occlusion
De winter’s T waves
Wellen’s
Differentials of tall T waves
Hyperacute T waves in early STEMI
Hyperkalemia
De winter’s T waves
Benign early repolarisation
Differentials of ST depression
Ischaemia
Posterior STEMI (inferopost or isolated post)
Left main coronary artery occlusion
De Winter’s T waves (proximal LAD occlusion)
Severe hypokalemia
Left main coronary artery occlusion
ST depression in 6 or more leads, esp inferior leads
ST elevation in lead avR >/= V1
- STEMI equivalent
Characteristics of De Winter’s T waves
- Tall, symmetrical T waves in precordial leads*
- Upsloping ST depression in precordial leads*
- Reciprocal ST segment elevation (0.5 – 1mm) in aVR
- Absence of ST elevation in precordial leads
Significance of De Winter’s T waves
Anterior STEMI equivalent due to ACUTE occlusion of proximal LAD
- Requires emergent reperfusion therapy
ECG features of hypokalemia
- Widespread ST depressions
- Flattened/Inverted T waves
- Prominent U waves
- Long QU interval
Clinical features to point towards possibility of hypokalaemia in a patient
ESRF
Frusemide
Diarrhoea
ECG features of Wellen’s syndrome
T wave abnormalities in leads V2-V4
- Type A: Biphasic T waves
- Type B: Deeply inverted T waves
No precordial Q waves
Persistent R waves
*ECG pattern is present in pain-FREE state
Significance of Wellen’s syndrome
Subacute occlusion of proximal LAD
- high risk of anterior STEMI within a week
- treated as a STEMI-equivalent (needs PCI)
What is Wellen’s syndrome?
Angina with T wave inversion in the LAD distribution, particularly V2-V4
Significance of de winter’s or wellen’s: THINK OF
Proximal LAD occlusion
- de winter’s (ACUTE): immediate cardiac catheterisation
- wellen’s (SUBACUTE): early cardiac catheterisation
What is Brugada sign?
Coved ST segment elevation in >1 of V1-V3 followed by a negative T wave
Criteria for Brugada syndrome
ECG pattern pattern +ve
AND
Syncope OR
Fam hx of SCD OR
Fam hx of PPM/AICD
Genetic testing
Definitive treatment in Brugada syndrome
Automatic Implantable Cardioverter Defibrillator
Risk of Brugada syndrome
Sudden cardiac death from ventricular arrhythmia
ECG features: Benign early repolarisation
- Widespread ST-segment elevation in leads II, III, aVF, leads V2-V6
- J-point notching in inferior leads (“fish hook appearance”)
- Prominent asymmetrical peaked T waves
- Lack of reciprocal changes
ECG features: Pericarditis
Stage 1 (first 2 weeks):
1. widespread STE and
2. PR depression with
*changes more pronounced in lead 2 > 3
3. reciprocal ST depression and PR elevation in aVR
4. +/- Spodick’s sign in acute pericarditis: downsloping TP segment
5. +/- Sinus tachycardia in acute pericarditis
Stage 2 (1 to 3 weeks): normalisation of ST changes; generalised T wave flattening
Stage 3 (3 to several weeks): flattened T waves become inverted
Stage 4: ECG returns to normal
Isolated posterior MI is due to occlusion of
left circumflex artery
