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ECGs > STEMI Patterns And Mimics > Flashcards

STEMI Patterns And Mimics Flashcards

1
Q

Lateral STEMI

A

ST elevation in lateral leads I, aVL, V5 & V6. Reciprocal depression in Inferior leads (III & aVF).

Usually occurs as part of a larger infarct e.g. anterolateral.

Supplied by branches of the LAD and LCx.

ST elevation in leads I & aVL only is a high lateral STEMI.

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2
Q

Inferior STEMI

A

ST elevation in leads II, III and aVF.

Reciprocal depression in aVL.

Most commonly involves RCA (80%). Can also be due to occlusion of LCx (18%).

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3
Q

Right Ventricular Infarction

A

Patients with Inferior Stemi, who also have ST elevation in V1.

ST depression in V2.

ST elevation in lead III is higher than in lead II.

ST elevation in V4R has a diagnostic accuracy of 83% for right ventricular infarction.

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4
Q

Anterior STEMI

A

ST elevation in V4 & V5.

ST elevation must be more than 2ms amplitude in V1, V2 & V3.

Often occurs as part of a larger area of infarction.

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5
Q

Anterolateral STEMI

A

ST elevation in V1-V6, I & aVL.

Reciprocal changes in inferior leads II, III and aVL.

Due to LAD occlusion.

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6
Q

Inferolateral STEMI

A

ST elevation in inferior leads (II, III & aVF), and lateral leads (I, aVL, V5 & V6).

May also have associated posterior infarction, indicated by ST depression in V1-V3.

May be due to occlusion LAD or left circumflex artery in a Left dominant system. Could also be proximal circumflex artery.

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7
Q

Inferoposterior MI

A

ST elevation in Inferior leads (II, III & aVF), and Posterior leads (V7, V8 & V9).

Reciprocal ST depression V1 & V2.

Due to Right coronary artery (RCA) and Left circumflex artery (LCx) occlusion.

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8
Q

Posterior STEMI

A

ST elevation in V7, V8 & V9.

Reciprocal ST depression in V1 & V2.

May be due to Right coronary artery (RCA) and Left circumflex artery (LCx) occlusion.

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9
Q

Septal STEMI

A

ST elevation in Septal leads (V1 & V2).

Commonly occurs in conjunction with Anterior MI.

Reciprocal changes in Posterior leads (V7, V8, V9).

> 2ms of elevation in V1 - V3 required for STEMI diagnosis for St John procedures.

Due to Left anterior descending artery (LAD) occlusion.

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10
Q

Posterolateral STEMI

A

ST elevation in Posterior leads (V7, V8 & V9), and Lateral leads (1, aVL, V5 & V6.

Reciprocal ST depression in V1 & V2.

Due to Left anterior descending artery (LAD) and Left circumflex artery (LCx) occlusion.

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11
Q

Coronary Vasospasm (Prinzmetal’s Angina)

A

STEMI mimic.

May mimic any STEMI pattern variant.

Temporary vasospasm causing reduction in blood flow. Changes are transient, reversible with vasodilators and not usually associated with myocardial necrosis.

May not be possible to distinguish from acute STEMI based on ECG only.

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12
Q

Pericarditis

A

STEMI mimic.

Widespread concave ‘saddleback’ ST elevation and PR segment depression, typically involving leads I, II, III, aVF, aVL, V2, V3, V4, V5 & V6.

Reciprocal ST depression and PR segment elevation in lead aVR, and sometimes V1.

Sinus tachycardia common.

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13
Q

Benign Early Repolarization

A

STEMI mimic.

Mild ST elevation with tall concordant T waves, mainly shown in V2 - V6.

Often there is notching of the J point, appearing like a fish hook.

No reciprocal ST depression.

Normal variant of ECG common in young, healthy patients.

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14
Q

Left Bundle Branch Block

A

STEMI mimic.

ST elevation in leads with deep S waves: V1, V2 & V3.

ST depression in leads with tall R waves: I and aVL.

ST segments and T waves show appropriate discordance - they are opposite to the main direction of the QRS. Causes ST elevation in leads w negative QRS and ST depression in leads with positive QRS.

V1 = W, V6 = M. “William Morris”

Wide QRS complex >120ms.

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15
Q

Left ventricular hypertrophy

A

STEMI mimic.

ST elevation in leads with deep S waves (V1, V2 & V3), and ST depression in leads with tall R waves (I, aVL, V5 & V6).

Sokolov-Lyon criteria: S wave in V1 + tallest R wave in V5 or V6 = more than 35mm.

Very similar to LBBB, except voltage extremes will be higher in Left ventricular hypertrophy.

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16
Q

Ventricular Aneurysm

A

STEMI mimic.

Residual ST elevation and deep Q waves, remaining after acute STEMI. Due to scar tissue formation.

Most commonly seen in precordial leads (V1 - V6).

No reciprocal changes. No dynamic changes.

17
Q

Brugada Syndrome

A

STEMI mimic.

ST elevation >2mm in more than 1 of V1, V2 and V3 with coved (upside down) morphology, followed by negative T wave.
Type 2 has >2mm of saddleback elevation in same leads.

Inherited channelopathy (disease of myocardial sodium channels), leading to paroxysmal ventricular arrhythmias and sudden death.

ECG must correlate with clinical criteria to be diagnosed.

18
Q

Ventricular Pacing

A

STEMI mimic.

Appropriate discordance - lateral leads with tall R waves will have ST segment depression and T wave inversion, leads with deep S waves will have ST elevation (V1, V2, V3, V4).

ST elevation is not concerning if less than 25% of the preceding S wave.
If ST segments and T waves are concordant with the QRS complex be suspicious of acute MI.

Pacing spike preceding QRS complex. Wide QRS complex.

19
Q

Raised Intracranial Pressure

A

STEMI mimic.

ST segment elevation or depression. May mimic MI or pericarditis.

Widespread, deep T wave inversions. “Cerebral T waves”

QT prolongation.

Bradycardia - due to Cushing reflex.

20
Q

Takotsubo Cardiomyopathy

A

STEMI mimic.

New ECG changes may mimic STEMI presentations. Unable to differentiate from STEMI pehospitally.

Diagnosed by echocardiography which shows movement abnormalities of the left ventricle, and angiography, which will not show occlusion.

Occurs in the context of severe emotional distress.

21
Q

Right Bundle Branch Block

A

Prolonged QRS >120ms.

RSR pattern in V1, V2 & V3 - bunny ears.

V1 = M, V6 = W. “Morris Williams”.

Wide, slurred S wave in lateral leads I, aVL, V5 & V6.

Appropriate discordance in QRS complexes and ST segment/T wave inversion in leads V1, V2 and V3.

Typically no ST elevation.

22
Q

Left Main Coronary Artery Occlusion

A

ST elevation in aVR more than 1mm.

ST elevation in aVR is higher than in V1.

Widespread, horizontal ST depression most obvious in leads I, II, V4, V5 & V6, but can be seen in all leads.

23
Q

Pulmonary Embolism

A

STEMI mimic.

Sinus tachycardia.

May show complete or incomplete RBBB.

Right ventricular strain pattern: T wave inversion in right precordial leads (V1, V2, V3 & V4), and inferior leads (II, III and aVF).

Non specific ST segment and T wave changes.

24
Q

Acute aortic dissection

A

STEMI mimic

Typically presents with ST elevation in Inferior leads (II, III & aVF), but can be non specific.

ST changes can be dynamic.

Type A extends along the ascending aorta towards the heart.

Type B starts in the descending aorta under the aortic arch and travels towards the abdomen.

25
Q

Hyperkalaemia

A

STEMI mimic.

Serum potassium >5.5: peaked T waves.

Serum potassium >6.5: P wave flattens and widens, PR segment lengthens, and P waves eventually disappear.

Serum potassium >7.0: prolonged QRS w bizarre morphology that may merge with P and T waves, high grade AV block, any kind of conduction block, sinus bradycardia or slow AF, development of a sine wave appearance for QRS.

Serum potassium >9.0: cardiac arrest

ECGs (3 decks)

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