Bicuspid/Mitral Chest Pain STEMI 
Dr. Smith's ECG Blog
APRIL 12, 2013
A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. He had no chest pain. Is this acute STEMI? Is this an acute STEMI? -- Unlikely! Medications were aspirin, clopidogrel, metoprolol, and simvastatin.
Dr. Smith's ECG Blog
SEPTEMBER 20, 2011
He did not state he had chest pain, but, then again, he couldn't remember anything. The structure at the bottom that is moving is the mitral valve, with anterior and posterior leaflets. This is as clear a STEMI as you can get. So this is classic inferoposterior STEMI on the ECG but is NOT acute coronary syndrome!
Dr. Smith's ECG Blog
APRIL 26, 2017
There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal. This meets "STEMI criteria" However, there is very high voltage, with a very deep S-wave in V2 and tall R-wave in V4. The morphology is not right for STEMI. What do you think?
EMS 12-Lead
MAY 20, 2022
Additional architectural changes include systolic anterior motion of the mitral valve, endothelial dysfunction at the level of the coronary arterial bed, and ventricular diastolic dysfunction. This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. Below are two examples of this.
Dr. Smith's ECG Blog
OCTOBER 23, 2022
EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 If it were me, I would get values at the level of the mitral valve, papillary muscles, and apex (all in PSS axis). She was having a transient STEMI, briefly. She called 911. I have been wrong before though!
Dr. Smith's ECG Blog
DECEMBER 18, 2022
Case A 39-year-old male without prior medical history presents with chest pain that started 2 hours prior to presentation. He says that the pain intensity was 10/10 at home but now about 4/10. Despite the clinical stability and decreasing pain, this patient needs an immediate angiogram. Here are his publications.)
BoardVitals - Cardiovascular
JANUARY 18, 2021
ACS QID 3103 A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chest pain. Severe mitral stenosis C. Acute mitral regurgitation E. Acute mitral regurgitation. Explanation: The EKG illustrates an inferior STEMI.
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