The 6 STEMI Equivalents:

* Posterior MI

* ST Depression V2/V3 (or STE in V7-V9)

* Right Ventricular MI

* STE V1 associated with inferior MI ; or STE V4R-V6R

* Wellens Syndrome

* Type A: Biphasic T-waves V2/3

* Type B: Deep Symmetric T-wave Inversion V2/V3

* De Winter’s T Wave

* ST Depression with a large, symmetric, upright T wave

* STE avR with diffuse ST-Depression

* Usually a strain pattern due to underlying pathology, in correct clinical context can represent a left main or proximal LAD coronary occlusion

* Modified Sgarbossa Criteria in LBBB

* Concordant STE in any lead

* Concordant ST Depression in V1-V3

* Excessive Discordance (ST/S ratio >0.25)

Other atypical ischemic EKG findings:

* Isolated TWI in avL – early sign of inferior MI

* Hyperacute TWave

* NTTV1 (New Tall T-wave in V1)

Further Reading (see photos in the article):

ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology