ACLS Revision: Is this Anteroseptal ischemia or Posterior MI?

Posterior MI

  • 4-10% of STEMIs are isolated posterior STEMI
  • Most common type of missed MIoften misdiagnosed as NSTEMI
  • The triad of ST depressions, upright Ts, and tall R waves (basically the equivalent of Q-waves) in V1-3 is suggestive of a Posterior MI
  • Only 30% are revascularized in 90 minutes
  • Usually associated with inferior or lateral MI due to RCA or circumflex occlusion

Wellens’ Syndrome STEMI

What is Wellens’ Syndrome?

  1. History of Angina
  2. ECG Changes (T-wave Inversions/Biphasic T-waves in leads V2 – V4)
  3. Normal to Minimally elevated Cardiac Enzymes
  4. No pathologic precordial q waves
  5. No loss of precordial R wave progression


Shock, syncope, sweating… and severe chest pain!

A 67-year old male is brought to hospital following an episode of syncope at home. He had just finished eating lunch at home when he developed severe crushing retrosternal chest pain radiating to his left arm, profuse sweating and vomiting. Shortly after the onset of the pain he lost consciousness and awoke to find himself on the floor. En route, he has several brief episode of dizziness and an impalpable radial pulse.

Chest Pain…

A man in his 60’s presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. There was some SOB. He had walked into the ED (did not use EMS). He was in no distress and vital signs were normal.