- Isolated Posterior Myocardial Infarction.
- Isolated ST-Depression in AVL
- Hyperacute T-waves (HATWs)
- De Winter Pattern
- ST Elevation (STE) in AVR
- Presumed New Left Bundle Branch Block
- ST-segment elevation in lead aVR portends a worse prognosis in ACS and often predicts the need for CABG.
- Hyperacute T-waves are not necessarily tall, and small T-waves can still be hyperacute when paired with a low-amplitude QRS complex.
- The tall T-waves associated with hyperkalemia are sharp, pointy, symmetric, and have a narrow base.
- When in doubt, get serial ECGs (every 15 minutes) and use adjunctive information.
There is obvious inferior ST elevation, with reciprocal ST Depression in aVL (inferior STEMI). There is also ST Depression in lead I. This is good evidence that the inferior STEMI is caused by an RCA occlusion. There is ST depression maximal in lead V2. Thus, there is a posterior STEMI. There is also ST depression in V5 and V6.
Where else is there evidence of STEMI?
- Treatment of pulmonary edema should be focused on ‘fluid redistribution’ and not ‘fluid removal’.
- First line: Nitroglycerin and NIV (start ASAP)
- Second line: ACE-I (in addition or instead of NTG)
- Third line: Diuretic like furosemide
- Morphine has NO ROLE in modern management of cardiogenic pulmonary edema
Causes of Elevated Troponin
|Noncardiac Causes||Cardiac Causes|
|Acute Noncardiac Critical Illness||Acute and Chronic Heart Failure|
|Acute Pulmonary Edema||Acute Inflammatory Myocarditis or Endocarditis/Pericarditis|
|Acute Pulmonary Embolism||Aortic Dissection|
|Cardiotoxic Drugs||Aortic Valve Disease|
|Stroke, Subarachnoid hemorrhage||Apical Ballooning Syndrome|
|Chronic Obstructive Pulmonary Disease||Bradyarrhythmia, Heart Block|
|Chronic renal failure||Cardiac contusion from trauma|
|Extensive Burns||Cardiac surgery, Post-percutaneous Coronary Intervention, Endomyocardial biopsy|
|Infiltrative Disease (Amyloidosis)||Cardioversion|
|Rhabdomyolysis with Myocyte Necrosis||Direct Myocardial Trauma|
|Sever Pulmonary Hypertension||Tachycardia/Tachyarrhythmia, Bradyarrhythmia|
|Strenuous Exercise/Extreme Exertion|