Podcast 628: ST Elevation

<p><strong>Contributor: Peter Bakes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">STEMI criteria is not just 1mm elevation in contiguous leads</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">1.5 mm in V2-V3 for women</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">2.0 mm in V2-V3 for men</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">2.5 mm in V2-V3 for men under 40</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Inferior MI typically have ST elevation in leads II, III and aVF</span></li> <li style="list-style: none; display: inline"> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Usually inferior MI’s show reciprocal changes (ST depression) in the lateral leads.</span></li> </ul> </li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Lateral MI typically elevation in V5, V6, I, and aVL</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Anterior MI show elevation in leads V1-4</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Right sided MIs have mixed pattern, showing elevation in V1-V2 and V4 along with the inferior leads.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Right sided MI’s are very sensitive to nitrates, especially if they become intubated because this combination can drop pre-load significantly leading to profound hypotension</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Akbar H, Foth C, Kahloon RA, et al.</span> <a href= "https://www.ncbi.nlm.nih.gov/books/NBK532281/"><span style= "font-weight: 400;">Acute ST Elevation Myocardial Infarction</span></a><span style="font-weight: 400;">. [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available fro