1. ECG – Acute Coronary syndromes
EMC SDMH 2015

3. ECG 1

4. The J point

5. Benign Early Repolarisation

6. ECG 2

7. ECG 3

8. ECG 4

9. ECG 5

10. RV infarction V1 elevation with inferior changes.
Confirm with presence STE in lead V4R

11. ECG 6

12. Reciprocal changes
STE will cause ‘injury current’ pattern (STD) on opposite of heart due to change in electrical vector
NOT due to subendocardial ischemia
If deep ST depression noted, consider STE in opposite side of heart
Remember ‘PAIL’
Posterior reciprocates to Anterior  Inferior  Lateral.
If not fitting this, consider further territory infarction

13. ?Posterior STEMI

14. Posterior STEMI Investigate with Posterior leads.
Only require 0.5mm to diagnose STE in Post. leads

15. ECG 6

16. LMCA Disease
Look for STE in aVR – ‘the forgotten lead’ – in setting of chest pain
>1mm STE OR; ST in aVR>V1 highly specific for Left main or severe 3VD
If occluded, high risk for cardiogenic shock
May require emergent CABG; consult before giving clopidogrel
May also been seen in tachyarrythmias, post-arrest, and TCA overdose

17. LMCA

18. ECG 7

19. Wellen syndrome Specific for high LAD lesion
Pt should not undergo EST!!!
2 patterns – Type A and B

20. ECG 8

21. Sgarbossa Criteria – STEMI in LBBB/Paced rhythm
STE concordance >1mm in contiguous leads (5 points)
STD concordance >1mm in V1-3 (3 points)
ST Discordance >5 mm in contiguous leads (2 points)
Score >3 = 90% specific for diagnosis STEMI in LBBB