We have no clinical information about this patient, except that he was complaining of chest pain, and was initially treated by prehospital paramedics.
ST Changes The paramedics noted a slight J point elevation in the precordial leads, specifically about one mm of elevation in Leads V2, V3, and V4. In addition, the ST segments are curved downward like a frown in V1 and straight in the remaining precordial leads. Because of the patient’s symptoms, and the ST abnormalities, they notified the hospital that they believed this was a STEMI. The patient was transported without complications, and the Emergency Department physician subsequently downgraded the initial assessment of STEMI Alert. We do not have access to follow up. These ST segments are abnormal, but do not necessarily indicate an acute ST-elevation M.I. (STEMI). A flat or “frowning” ST segment DOES suggest coronary artery disease, and the patient’s symptoms are worrisome. However, before activating the cath lab emergently, it is sometimes preferable to observe the patient, check cardiac enzymes and other lab results, and repeat ECGs.
Are These ST Changes Due to Acute M.I.? There are several accepted guidelines in use for evaluating ST segments for STEMI. Some are simplified for ease of use, and some are very detailed, taking into consideration the patient’s age and gender. There are ECG features that INCREASE the chances of ST elevation being due to acute M.I. These features include:
· ST elevations are in related leads