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

2. Criteria
Paul Sia
for diagnosing
STEMI
on ECG

3. 3rd Universal Definition of MI (2012)

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

7. Anterolateral STEMI
ECG 1

8. Inferior STEMI
ECG 2

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.