Emergency Medicine Cases - October 2019 - By McLaren J
Peer Reviewed and edited by Anton Helman
"In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. Can you identify which were early repolarization and which were anterior STEMI?...
Dr. Smith has developed a formula for differentiating early repolarization from subtle LAD occlusion, in cases where there is at least 1mm of STE in at least 1 anterior lead. It examines ST elevation relative to the QRS complex (higher in early repolarization) and QT interval (shorter in early repolarization). It is available on MD-calc, and begins with important BER exclusion criteria:
Take home points for early repolarization or anterior STEMI?
- LAD occlusion can have mild concave ST elevation that doesn’t meet STEMI criteria and that will be missed by automated interpretation–and labelled anything from “early repolarization” or “pericarditis” to “nonspecific” or even “normal“
- Early repolarization exclusion criteria and other signs of ischemia like hyperacute T waves or dynamic changes can identify LAD occlusion
- In subtle cases the Smith formula can help differentiate between early repolarization and LAD occlusion"