Archive for the ‘ACS’ Category


last part should be aVL

    From Hartman 4 Steps to STEMI Diagnosis AmJEM 2012: 1. Is there STE of at least 1 to 2 mm in 2 anatomically oriented leads? [rules in STE] 2. Is the sum of the Q wave in lead V1/V2 + R wave in lead V5/V6 less than 35 mm? [rules out LVH] 3. Is the QRS complex less than 0.12 second in width? [rules out IVCD – BBB or PCM] 4. Is there ST-segment depression present in at least 1 lead? [rules out BER and pericarditis]     From ERCast / Amal Mattu STEMI vs. pericarditis Step 1: Look for findings that clearly define STEMI. Is there any ST segment depression in the other leads leads (except AVR and V1-nonspecific). These are “reciprocal changes” and strongly suggest STEMI over other causes of ST elevation. Look at the ST segment elevation in Leads II and III. If the ST elevation in lead III is greater than in lead II, think STEMI. Early repolarization and pericarditis should not have more ST elevation in lead III compared to lead II. Look at the morphology of ST segment elevation. Concave upward (as in a cup holding water) does not rule out STEMI. If morphology is horizontal (tabletop) / convex upward (tombstone), think STEMI. Serial EKGs show increasing size of Q waves ( make sure they are new Q waves) = STEMI Step 2: Look for findings that define pericarditis. PR depression in multiple leads >2mm. But be warned, PR depression is not only seen in pericarditis. It can also be seen in STEMI,…

351. Early complications of AMI

July 6th, 2008
by reuben in ACS