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Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately.
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POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations.
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Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion. History is important as this can also be seen in other sick patient populations (e.g. Sepsis)
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De Winters T waves are the earliest sign of an anterior wall MI but will only be present in ~ 2% of LAD infarcts
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Patients with Wellens Syndrome on ECG should have a cardiac cath within 24 hours, not necessarily within the first 60 minutes of ED arrival.
REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion
Resources
- REBEL EM: Modified Sgarbossa Criteria: Ready for Primetime?
- Post Created By: William Caputo MD
- Post Peer Reviewed By: Anand Swaminathan MD, MPH (Twitter @EMSwami)
