07.15.2023 - By Zack Olson, MD and Michael Estephan, MD
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