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The 6 STEMI Equivalents:

  1. Posterior MI
    • ST Depression V2/V3 (or STE in V7-V9)
  2. Right Ventricular MI
    • STE V1 associated with inferior MI ; or STE V4R-V6R
  3. Wellens Syndrome
    • Type A: Biphasic T-waves V2/3
    • Type B: Deep Symmetric T-wave Inversion V2/V3
  4. De Winter’s T Wave
    • ST Depression with a large, symmetric, upright T wave
  5. STE avR with diffuse ST-Depression
    • Usually a strain pattern due to underlying pathology, in correct clinical context can represent a left main or proximal LAD coronary occlusion
  6. Modified Sgarbossa Criteria in LBBB
    • Concordant STE in any lead
    • Concordant ST Depression in V1-V3
    • Excessive Discordance (ST/S ratio >0.25)

Other atypical ischemic EKG findings:

  1. Isolated TWI in avL – early sign of inferior MI
  2. Hyperacute TWave
  3. NTTV1 (New Tall T-wave in V1)

Further Reading (see photos in the article):

ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology