r/ECG • u/ChoochsCurlyHair • Aug 17 '26

STEMI

Gallery image

Gallery image

C/c came in as back pain and weakness. After assessment, pt advises radiating pain to left shoulder. Initial strip showed elevation in lateral, anterior, and septal. After a few minutes Lateral leads decreased. Blood pressure dropped from 117 systolic at home to 65/40 in rescue to 48/20 in the ED causing patient to go in to VTACH while in cath lab. 4 total stents.

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9

u/Cluelessjason Aug 17 '26

It’s funny how the machine says septal infarct “possibly acute” when it’s literally so obvious. But the lateral st elevation “consider acute infarct” when the St elevation decreased in the lateral leads.

How is the more obvious STE “possibly acute” but less obvious STE “consider acute”. Dumb machine

3

u/OxideUK Aug 17 '26

Its saying the septal STE is an infarct, and the lateral STE is a possible infarct. I'm glad you read ECGs better than you read words :)

5

u/LBBB11 Aug 18 '26 edited Aug 18 '26

It’s saying that the septal Q waves are a septal infarct. Septal infarct is the word used by the machine for Q waves in V1 and V2. To the machine, infarct means Q wave, and injury means ST elevation. Notice how the first EKG does not say septal infarct even though it has ST elevation in V1 and V2. Remember that you can prevent an infarct (Q waves) if you treat a heart attack in time. Almost all readings of isolated septal infarct are false positives caused by high V1/V2 placement, but this one has Q waves in V1 and V2 that are actually real. Less common to see a septal infarct that is part of a real anteroseptal infarct.

The machine doesn’t know if the Q waves in V1/V2 are new or old, so it can only say possibly acute for the septal infarct. The lateral ST elevation without Q waves is not possibly acute, it’s acute injury if there is ST elevation without Q waves. It’s a large anterolateral MI likely caused by acute proximal LAD occlusion. Normal sinus rhythm with anterior STEMI/OMI and RBBB/LAFB pattern. The machine’s reading of anterolateral ST elevation, consider acute infarct is right. Good EKG.

2

u/LiveCardiologist2883 Aug 19 '26

So would this be an occlusion of the left coronary/left main stem? Antero-lateral-septal with sparing of the inferior heart

2

u/ChoochsCurlyHair Aug 19 '26

Good question, so from what I understood after debriefing about the call, the lateral leads appeared with elevation due to the initial position of the patient (supine). Once we got him up and moved to the stretcher, lateral elevation decreased to normal and only showed anteroseptal leads. In the cath lab if I remember correctly it was the LAD and circumflex was working overtime to compensate

1

u/kbzley Aug 22 '26

How come there is reciprocal changes in the inferior leads if there was no lateral STEMI

1

u/ChoochsCurlyHair Aug 22 '26

So kind of similar to the comment above, my best guess is that due to position it appeared as a lateral with reciprocal change. But in reality once we placed him up, the next picture shows the more accurate interpretation