STE at J point in 2 contiguous leads
- Men > 40 y/o : 2 mm in V2-3, 1 mm in other leads
- Men < 40 y/o : 2.5 mm in V2-3
- Women : 1.5 mm in V2-3, 1 mm in other leads
Posterior STEMI is easy to be missed !
V1-3 STD : Ant septal ischemia or Post STEMI ?
-> Post ECG ! No more flip test ~
Post arrest STEMI : Go to cath lab (Class Ib)
NSTEMI to Go to cath lab (Class I)
- Hemodynamic unstable (Post arrest) or eletrical unstable (VT/Vf)
- Intractable ischemia
- Acute decompensated Heart failure
Amal Mattu's class IIa indication
Not yet US guideline, already 2017 ESC guideline
New LBBB is out ! No more comparsion to old ECG ever !
LBBB appropriate discordance is normal
Criterion need only 1 lead is enough
RBBB will not associated with ST elevation -> No criterion, just find the cause of STE
- Broad QRS
- RSR' in V1-3
- Slurred S over V5-6, I, aVL
- Associated STD + Tinv over V1-3
Amal Mattu's class IIb indication
- Sgarbossa criteria also useful in AMI with pacemaker if RV pacing (LBBB pattern)
- D winter T : Acute proximal LAD occlusion, Urgent Cath should be considered
- aVR STE + diffuse STD in symptomatic patient : LMCA, TVD, Proximal LAD
If no symptoms, aVR not important
Without diffuse STD, non specific finding of aVR STE
* Other D/D : anemia, dissection, PE, Hyper/Hypo K, Na channel blocker
所以病史非常重要, If Non ACS story, think other treatable cause first
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