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STEMI &
The ECG is the most important test in the workup of ACS.
The ECG is the most important test in the workup of ACS.
Obtain one in the first 10 mins to help identify those with occlusion MI that may benefit from emergent reperfusion.
Always compare the initial ECG (may be normal in ACS) to previous ECGs.
Traditionally, the "classic STEMI criteria" is used to identify occlusion MI. Unfortunately, the classic STEMI criteria are neither sensitive or specific for acute coronary occlusion. Always looks for ECG signs of occlusion MI in patients with symptoms of ACS.
ACTIVATE THE CATH LAB!
ACTIVATE THE CATH LAB!
The following links summarize the commonly accepted international criteria for STEMI (+) occlusion MI:
ACTIVATE THE CATH LAB?
ACTIVATE THE CATH LAB?
The following links summarize concerning ECG findings that are STEMI (-) but suggest occlusion MI:
The false positives
The false positives
Whenever considering STEMI, it is also important to consider the conditions that may mimic STEMI:
KEY PEARL:
KEY PEARL:
The current US guidelines recommend emergency reperfusion for STEMI, or NSTEMI with electrical or hemodynamic instability, & ongoing ischemia despite maximum medical management!
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