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STEMI or NOT! What do you Think?

by on August 4, 2011

Here is a strip I found on our monitor. I can not tell you much about patient presentation other then she was experiencing chest pain

HR 80
QRS 119
QT 396
QTC 457

QRS -53
T 66

Lead II

12 Lead

From → Education

  1. I think there is enough for lateral/high lateral STEMI with several other ekg findings- short QT? r/o hyperkalemia QRS widening, tented t waves? Those are observation im not so sure about on this EKG at this time. I do see concordant STE V5 V6 I. What I see as likely reciprocal depressions in lead II, III. Im glad im getting this one on a blog. Ill pull the stemi trigger and prepare to be humbled

  2. Wide, V1-negative with broad R’s in Leads I and V6: LBBB. Inappropriately concordant ST segments in I, aVL, V5-V6. Excessively discordant elevation in V2. I agree with Chris that Lead II looks like it has inappropriately isoelectric ST segments (relative ST-depression).

    I’d be comfortable with STEMI in the face of LBBB.

  3. I too am on the same page that this looks like LBBB with concordant ST elevation in the Lateral Leads. I believe I would call this a STEMI and transport accordingly. I will definitely see if I can find out about this case and get and update if possible

  4. Anonymous permalink

    Without a previous EKG for comparison…yes…CCL now.

  5. I’d call it a lateral STEMI due to >1 mm ST-elevation concordant with the QRS. I’d treat just like any other STEMI, including a code 3 ride to the nearest PCI center.

    As ‘P’ is abscent—Junctional Rhythem to..(Involvment of SAN in d progresson of infarction)

  7. Dave B permalink

    just to add to Chris and Christopher’s comments, the Q wave in aVL looks pathologic.

  8. Medic Jesse permalink

    Im going to say LVH with a LBBB. Treat for CP per ACLS and transmit the 12 lead. There is no discernible depression in the reciprocal leads that might indicate a STEMI. This could be an NSTEMI.

  9. Anonymous permalink

    I say LBBB and LVH.. so, with 2 “STEMI” imposters, I would treat the patient with the chest pain protocol, and take them to a cath lab facility, but wouldn’t activate a STEMI. I would also do a cardiac enzyme kit, and check for any elevation in blood work (we carry kits on our ambulances).

  10. stemi in LBBB per fesmire
    stemi in LBBB per brugada

  11. Sorry, I meant sgarbossa on the latter

  12. Harrison,

    I’m interested in your Fesmire reference! Can you share his criteria?

  13. Jay permalink

    No STEMI because of LVH.

  14. Troy permalink

    Rhythm is a sinus with LBBB. The picture won’t enlarge on my phone so some of this might be wrong. Although V2 & V3 have extensive elevation, I believe it is proportionate to the S wave depth using the Smith-Sgarbossa Modified formula. There is inappropriate ST concordent elevation in V5, V6, I, and aVL with reciprocal changes in III and possibly II as well which is diagnostic for a lateral MI

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