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Stemi criteria

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The document provides criteria for diagnosing ST-elevation myocardial infarction (STEMI) on electrocardiogram (ECG). It lists cut-off values for ST elevation in different leads used to identify STEMI based on the patient's age, sex and lead location. It cautions that baseline ECG abnormalities like left bundle branch block (LBBB) could obscure interpretation and provides examples of STEMI in different heart locations identified by affected leads on ECG.

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STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
Criteria Paul Sia for diagnosing STEMI on ECG
3rd Universal Definition of MI (2012)
STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
General pitfalls • Beware of baseline ECG abnormalities that may obscure interpretation • LBBB • refer to Sgarbossa’s criteria • LVH • J-point elevation syndromes eg, Brugada • PE • Peri/myocarditis • Cardiomyopathy, including Takotsubo • Cocaine use • Cardiac pacing
STEMI location • septal • V1, V2 • inferior • II, III, aVF • reciprocal changes: I, aVL • lateral • I, aVL, V5, V6 • reciprocal changes: II, III, aVF • anterior • V3, V4 • anteroseptal • V1, V2, V3, V4 • anterolateral • I, aVL, V3, V4, V5, V6 • reciprocal changes: II, III, aVF • posterior • V7, V8, V9 • reciprocal changes: V1, V2, V3, V4
Anterolateral STEMI ECG 1
Inferior STEMI ECG 2
ECG 3 Inferolateral STEMI + Horizontal ST depression V1-3 + Tall R waves, upright T-waves V2-3
ECG 3 + posterior leads Inferior-lateral-posterior STEMI
References • Bax, Jeroen J., et al. "Third Universal Definition of Myocardial Infarction." Journal of the American College of Cardiology 60.16 (2012): 1581-1598.

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Stemi criteria

  • 1. STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
  • 4. STEMI on ECG • New ST elevation at J-point in 2 contiguous leads with cut-points: • ≥ 0.2 mV in men ≥ 40 years in leads V2 - V3 • ≥ 0.25 mV in men < 40 years in leads V2 - V3 • ≥ 0.15 in women in leads V2 - V3 • ≥ 0.1 mV in all other leads • In the absence of LVH and LBBB examples of ST-elevation in MI
  • 5. General pitfalls • Beware of baseline ECG abnormalities that may obscure interpretation • LBBB • refer to Sgarbossa’s criteria • LVH • J-point elevation syndromes eg, Brugada • PE • Peri/myocarditis • Cardiomyopathy, including Takotsubo • Cocaine use • Cardiac pacing
  • 6. STEMI location • septal • V1, V2 • inferior • II, III, aVF • reciprocal changes: I, aVL • lateral • I, aVL, V5, V6 • reciprocal changes: II, III, aVF • anterior • V3, V4 • anteroseptal • V1, V2, V3, V4 • anterolateral • I, aVL, V3, V4, V5, V6 • reciprocal changes: II, III, aVF • posterior • V7, V8, V9 • reciprocal changes: V1, V2, V3, V4
  • 9. ECG 3 Inferolateral STEMI + Horizontal ST depression V1-3 + Tall R waves, upright T-waves V2-3
  • 10. ECG 3 + posterior leads Inferior-lateral-posterior STEMI
  • 11. References • Bax, Jeroen J., et al. "Third Universal Definition of Myocardial Infarction." Journal of the American College of Cardiology 60.16 (2012): 1581-1598.