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STEMI – Anterior Wall

All About Cardiovascular System and Disorders

STEMI – Anterior Wall ECG shows ST elevation myocardial infarction of anterior wall. Up sloping elevation of ST segment is seen in leads V1 to V5, with maximum ST elevation in V2, as is characteristic of anterior wall infarction.

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Sometimes even ST Elevation meeting criteria is not enough to be convincing

Dr. Smith's ECG Blog

There is STE in inferior leads now (The unfortunate thing about these leads is the conventional naming that labels them as inferior, which could not be more misleading in electrophysiological terms. See bibliography).

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STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is atrial fibrillation.

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Brugada Syndrome

All About Cardiovascular System and Disorders

I am always happy to see this ECG of Brugada syndrome sent to me by Professor Josep Brugada, in 2001, for the inaugural issue of the Indian Pacing and Electrophysiology Journal, which I started in 2001. And, this pattern can occur with or without symptoms and sometimes with a family history of sudden cardiac death.

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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. She has not yet been seen by electrophysiology or had further genetic testing for Brugada syndrome. So maybe she is better than I am. It is always prudent to be cautious!

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. She has not yet been seen by electrophysiology or had further genetic testing for Brugada syndrome.

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Inferior ST elevation with reciprocal change: which of these 4 patients has Occlusion MI?

Dr. Smith's ECG Blog

Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. Theres inferior STE which meets STEMI criteria, but this is in the context of tall R waves (18mm) and relatively small T waves, and the STD/TWI in aVL is concordant to the negative QRS. This was false positive STEMI with an ECG mimicking OMI.