Acute MI

When students are learning to recognize ST elevation M.I. (STEMI), they often want to know, "How many blocks does the ST segment have to be elevated for it to be a STEMI?".  Counting blocks simply does not work.  Depending on the experience level of your students, it is important to introduce other characteristics of the ST elevation.

Even subtle elevations can indicate acute M.I. when other features are present.  These include, ST elevation in related leads, a flat or coved upward ST segment, associated signs such as T wave inversion and pathological Q waves, reciprocal depressions, and of course patient presentation.

This ECG shows subtle ST elevations. The LifePak 15 (PhysioControl) has read it as "Meets ST Elevation MI Criteria".  LifePak 15 uses the University of Glasgow criteria, which takes into consideration the age and gender of the patient, among other things. The paramedics who cared for this patient were confused because she had chest pain, and the LifePak said she had MI criteria, but they counted blocks and did not find 1 mm ST segment elevation as they were taught.  To the experienced eye, of course, this ECG looks like the CLASSIC inferior wall MI, with the classic bradycardia (junctional rhythm) often seen.  This patient was evaluated in the cath lab, and treated for acute STEMI.