Chest Pain in Atrial Fibrillation

This is a great example of how the dichotomy between STEMI and Non-STEMI is false.  They are both due to thrombus in the coronary artery and both are very dangerous.  STEMI and NonSTEMI exist on a spectrum.  Thrombus can lyse and propagate, and NonSTEMI can convert to STEMI.


The STEMI ECG Assessment

This ECG assessment is designed to evaluate your ability to use simply the 12-Lead ECG to make the diagnosis of a coronary artery occlusion. It uses a standardized list of 36 ECG’s from McCabe JM, et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013;2:e000268.

Where else is there evidence of STEMI?

Inferior STEMI

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?