Defining the STEMI - Case Review | The EM Cardiology Course

[@HyperkalemiaSineWave]

Heyyy, new Amal mattu content!

[@tekiy1690]

Great lecture...thank you

[@husseinbarakathbg]

If you turn the aVL to an -aVL (and flip it) then it will actually make 2 continuous leads of STEMI, III and -aVL. So the criteria of 2 continuous leads is actually met on the first ecg.

[@laffertyesq]

Interesting. How would you turn aVL into -aVL?

[@husseinbarakathbg]

@@laffertyesq turn it upside down.

[@sorenjorgensen5334]

@@husseinbarakathbg Except that AVL and III are not contiguous

[@husseinbarakathbg]

@@sorenjorgensen5334 -aVL Minus

[@amineorianthi]

thanks !

[@sreeraj1216]

sir, what to do when there are more than 2 morphologies of ST elevation in the same lead, like one in the above example ?

[@workuabageda1623]

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[@chrism6904]

You do not need ST elevation in two contiguous leads in a inferior MI. You could have only ST elevation in lead 3 and reciprocal change in AVL and that is enough to be a STEMI alert. Most people don’t know this.

[@fredastaire6156]

Can we have a citation source please?

[@chrism6904]

@@fredastaire6156 I learned it from Dr. Stephen Smith… one the best in the world at ECG interpretation. I can’t remember the exact place I found it. Lead III provides a direct view of the inferior portion of the heart, and ST elevation here is highly indicative of ischemia or infarction in that region. The reciprocal change observed in lead aVL, which views the heart from a direction opposite to the inferior leads, further corroborates the diagnosis. Reciprocal depression in aVL serves as a critical clue, suggesting that the ST elevation in lead III is not a benign finding but rather a sign of ongoing myocardial injury. In this context, even if leads II and aVF do not exhibit ST elevation, the combination of ST elevation in lead III and reciprocal depression in aVL is enough to raise clinical suspicion for an acute inferior OMI. Given the high stakes of myocardial infarction, where time is myocardium, this constellation of ECG findings justifies immediate intervention, hence the activation of a STEMI alert.

[@alia.al-mubarak6352]

Can we have the citation?

[@husseinbarakathbg]

@@chrism6904 yes! A reciprocal change in aVL is similar to a STEMI in "-aVL" which is a continuous lead to III.

[@scrumptious9673]

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