Podcast 628: ST Elevation

Contributor: Peter Bakes, MD

Educational Pearls:

• STEMI criteria is not just 1mm elevation in contiguous leads
• • 1.5 mm in V2-V3 for women
  • 2.0 mm in V2-V3 for men
  • 2.5 mm in V2-V3 for men under 40
• Inferior MI typically have ST elevation in leads II, III and aVF
• • Usually inferior MI’s show reciprocal changes (ST depression) in the lateral leads.
• Lateral MI typically elevation in V5, V6, I, and aVL
• Anterior MI show elevation in leads V1-4
• Right sided MIs have mixed pattern, showing elevation in V1-V2 and V4 along with the inferior leads.
• Right sided MI’s are very sensitive to nitrates, especially if they become intubated because this combination can drop pre-load significantly leading to profound hypotension

References

Akbar H, Foth C, Kahloon RA, et al. Acute ST Elevation Myocardial Infarction. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532281/

Namana V, Gupta SS, Abbasi AA, Raheja H, Shani J, Hollander G. Right ventricular infarction. Cardiovasc Revasc Med. 2018 Jan;19(1 Pt A):43-50. doi: 10.1016/j.carrev.2017.07.009. Epub 2017 Jul 14. PMID: 28822687.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD

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