- 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?
Posterior STEMI is 10 – 15% of all STEMIs, but it is often missed and here is why….
In the setting of ACS, ST depression in leads V1 – V3 means one of two things:
1. Anterior Ischemia
2. Posterior STEMI
Obviously these two entities are treated differently. So don’t be burned by ST depression in leads V1 – V3 and miss that posterior STEMI. Be sure to get posterior leads to confirm or exclude your diagnosis.
While men generally exhibit the typical symptoms of chest pressure and pain, women generally exhibit symptoms that are not well-known, leading them to delay seeking treatment. Women who are having a heart attack often feel pain in areas outside the chest, including the jaw, neck, abdomen, legs, and arms. Severe fatigue, sweating, or shortness of breath can also be present, leading women to feel as if they just ran a marathon even though they are standing still. Many women who have had heart attacks also mistake the chest pain for heartburn, indigestion, or a stomach ulcer.