Occlusion MI vs STEMI: A Paradigm Shift in ECG Interpretation for Myocardial Infarction
This video reviews updated ECG interpretation criteria for more sensitive detection of occlusion MI in the emergency department.
Key takeaways include:
- The differential of ST elevation includes hyperkalemia, baseline conduction (LBBB, early repolarization), structural changes (LVH, LV aneurysm), acute ischemia or inflammation (including coronary vasospasm, myocarditis or takotsubo), and miscellaneous rarer causes.
- STEMI criteria misses 25% of acute coronary occlusions that don’t meet criteria, and can result in unnecessary cath lab activation for ST elevation not caused by acute occlusion.
- In cases of concave and borderline ST elevation, Q waves, terminal QRS distortion, ST depression, T wave inversion, reciprocal changes, and a formula for subtle cases can differentiate LAD occlusion from benign repolarization.
- While STEMI criteria has poor sensitivity for inferior MI, reciprocal ST depression in aVL is much better at identifying subtle inferior MI and differentiating MI from pericarditis.
- While Q waves can develop within an hour of occlusion, the ratio of T waves to QRS complex can distinguish anterior STEMI from old LV aneurysm morphology.
- The modified Sgarbossa criteria can identify occlusion MI in the presence of LBBB.
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