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The 6 STEMI Equivalents:
- Posterior MI
- ST Depression V2/V3 (or STE in V7-V9)
- Right Ventricular MI
- STE V1 associated with inferior MI ; or STE V4R-V6R
- Wellens Syndrome
- Type A: Biphasic T-waves V2/3
- Type B: Deep Symmetric T-wave Inversion V2/V3
- De Winter’s T Wave
- ST Depression with a large, symmetric, upright T wave
- STE avR with diffuse ST-Depression
- Usually a strain pattern due to underlying pathology, in correct clinical context can represent a left main or proximal LAD coronary occlusion
- Modified Sgarbossa Criteria in LBBB
- Concordant STE in any lead
- Concordant ST Depression in V1-V3
- Excessive Discordance (ST/S ratio >0.25)
Other atypical ischemic EKG findings:
- Isolated TWI in avL – early sign of inferior MI
- Hyperacute TWave
- NTTV1 (New Tall T-wave in V1)
Further Reading (see photos in the article):
ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology