Podcast 826: STEMI Equivalents

<p><strong>Contributor: Travis Barlock, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue</span></li> </ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Patients with occluded coronary arteries can present with EKG findings other than STEMI</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department</span> <span style="font-weight: 400;">was recently published in the Journal of the American College of Cardiology</span></li> </ul> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Recognizes STEMI equivalents that necessitate cath lab management</span></li> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">ST depression in precordial leads</span></li> <ul> <li style="font-weight: 400;" aria-level="3"><span style= "font-weight: 400;">Indicates a posterior infarct/possible RCA occlusion</span></li> </ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">LBBB c ST elevation meeting modified Sgarbossa criteria</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Hyperacute and/or De Winter T wave</span></li> <ul> <li style="font-weight: 400;" aria-level="3"><span style= "font-weight: 400;">First indication of coronary artery occlusion</span></li> <li style="font-weight: 400;" aria-level="3"><span style= "font-weight: 400;">Most beneficial time to initiate cath lab because