Additional Resources

The Royal College of Emergency Medicine (UK) induction reading on CP is well worth a read

https://www.rcemlearning.co.uk/modules/chest-pain-induction/

LITFL ECG library for ECG practice

https://litfl.com/ecg-library/ 

Quiz

This exercise is intended to stimulate further reading into carious STEMI presentations and STEMI equivalents. Have a close look at these ECGs, answer the questions and then check your answers at the end of the page.

Question 1.

Which of the following description about this ECG is incorrect?

a.  Reciprocal ST depression and T wave inversion in aVL.

b.   Hyperacute [peaked] T waves in II, III and aVF with relative loss of R wave height.

c.   ST elevation in lead III>lead II suggests an LCx occlusion; the subtle ST elevation in V4R would be consistent with this.

d.   Early ST elevation and Q-wave formation in lead III

Question 2.

All the ECG features of right ventricular infarction are correct except?

a.   ST elevation in V1<V2

b.   ST elevation in V1

c.   ST elevation in lead III > lead II

d.   ST elevation in V1 + ST depression in V2

Question 3.

Which of these ECG features makes RV infarct more likely?

a.   Reciprocal ST depression in aVL

b.   ST elevation in lead III > lead II

c.   Isoelectric ST in V1 and ST depression in V2

d.   ST elevation V4R > 0.5 mm

Question 4.

Which treatment is contraindicated for a patient with this ECG?

a.   Aspirin + Ticagrelor

b.   IV Fluids

c.   IV Morphine

d.   Nitrates

Question 5.

What features on this ECG do not suggest a posterior extension of inferolateral STEMI?

a.  Upright T waves in inferolateral leads.

b.  Tall, broad R waves [>30ms] in V2-3

c.   Horizontal ST depression in V1-3

d.   Dominant R wave [R/S ratio >1] in V2

Question 6.

What features of this ECG are suggest an anterior STEMI?

a.   Hyperacute T-waves in V2-V6

b.   Premature atrial complexes

c.    Multifocal ventricular ectopy

d.    Left axis deviation

Question 7.

Which of the below given statement is incorrect regarding this ECG?

a.   ST elevation aVR > V1 is indicative of proximal LAD occlusion.

b.   ST elevation in aVR combined with diffuse ST depression in anterolateral leads is predictive of LMCA occlusion.

c.   ST elevation in aVR >1mm is indicative of LMCA occlusion

d.   Administration of clopidogrel along with aspirin in a patient with STE in aVR should be done only after discussion with Cardiology team.

Question 8.

All of the below given information regarding this ECG [De Winter T waves] is correct, except?

a. Up-sloping ST depression in the precordial leads

b.  Peaked anterior T waves, with the ascending limb of the Twave commencing below the isoelectric baseline

c.  ST elevation in aVR >0.5 mm

d.  This patient is likely to have LMCA occlusion

Question 9.

Which abnormalities from this ECG consistent with Wellen’s syndrome, except?

a.   Biphasic T waves in anterior leads

b.   Minor precordial ST elevation

c.   No precordial Q waves

d.   Poor R wave progression

Question 10.

Based on the ECG findings, what is the probable diagnosis in this patient with chest pain?

a.  Wellens syndrome

b.  Dewinter T waves

c.  Anterior AMI

d.  Pulmonary Embolism