STEMI-59

Pre-hospital ECG

Emergency Department ECG

• Patient had MI 1 week ago with stent placement

Cardiac Cath Report

Normal coronaries with patent stent

Echo: Akinetic inferior, lateral, anterior and septal LV wall

Teaching

• There are a few causes of continued ST elevation after an MI that need to be thought of:
  • Another MI
  • Stent thrombosis (usually patient will not be compliant with anti-platelets they were discharged on)
  • Left ventricular aneurysm
• Factors suggesting MI/stent thrombosis
  • New ST changes compared with previous ECGs.
  • Dynamic / progressive ECG changes — the degree of ST elevation increases on serial ECGs.
  • Reciprocal ST depression.
  • High clinical suspicion of STEMI — ongoing ischemic chest pain, sick-looking patient (e.g. pale, sweaty), hemodynamic instability.
• LV Aneurysm
  • Can occur in up to 60% of Anterior MI
  • Infarcted LV wall balloons out
  • ECG criteria: Persistent ST elevation 1-2 weeks after MI + well formed Q waves
  • More information HERE

Click here to watch video lecture covering multiple causes of “STEMI Mimics”