Inferior Wall Reciprocal
aVL is the only lead truly reciprocal to the inferior wall, as it is the only lead facing the superior part of the left ventricle
OMI T Wave
There is no formal, universal definition of what represents a HATW, however it is recognised that the ratio of T wave amplitude to the preceding complex is of more significance than overall T wave size. HATWs are wider and generally more symmetric than normal T-waves
Isolated Posterior MI
ST depression maximal in leads V1-4, without progression to V5-6, should be considered a posterior OMI until proven otherwise, even in the absence of ST elevation in leads V7-9
aVR Elevation
Lead aVR was previously assumed to carry little diagnostic value, as it’s vector is directed away from left ventricular depolarisation. ST elevation > 1mm in lead aVR has been shown to be 80% sensitive and 93% specific for left main or triple vessel disease in patients with NSTEACS
PE Sign
T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS with Sinus Tach / Hypoxia
Hyperkalemia
Killer B’s
Broad
Brady
Blocks
Bizarre
Leads Q should never exist
V2, V3
Hyperacute T Waves
Usually, the defining feature of hyperacute T waves is that they are abnormally fat and broad, as if being inflated with air from below, causing increased area under the curve of the ST-T waves. I teach that hyperacute T waves look like they are being inflated with air, while hyperkalemic T waves look like a tent being pitched with a pole.
LAD Occlusion pattern “Precordial Swirl,”
STE in V1 and aVR, with reciprocal STD in V5 and V6.
Sgarbossa
- Sgarbossa lbbb and paced (wide qrs)
- > 5mm discordant 2 points
- STD >1mm v1-V3 3 points
- Concordant ste >1mm 5 points
- Need 3 to qualify
- Left is down and right is up for bundle branch
- Dewinter t waves
- Dewinter t waves
- Upsloping st depression in v leads
- Ste avr >.5mm
Wellens
- Wellens
- Deeply inverted v2-3
- Biphasic positive to negative
- Avr greater elevation than one mm than v1
- Depression of v’s
AvL Depression
- Avl depression with subtle inferior elevation
- .5 depression is present in 97% of cases
