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13 ste-mimics part4
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13 ste-mimics part4

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  • 1. 12-Lead Electrocardiography a comprehensive course Adam Thompson, EMT-P, A.S.
  • 2. Acute Pericarditis• Inflammation of the pericardium (pericardial sac).• May present with global STE• STE may appear pronounced due to PR- depression.• Tip - STE will be present in reciprocal leads• aVR will present with ST-depression
  • 3. Acute Pericarditis• Stage I
everything is UP – ST elevation in almost all leads• Stage II
Transition – "pseudonormalization"• Stage III
Everything is DOWN – inverted T waves• Stage IV 
Normalization.
  • 4. Acute PericarditisStage 1 Stage 2 Stage 3
  • 5. Acute Pericarditis
  • 6. Acute Pericarditis
  • 7. Acute Pericarditis
  • 8. Hyperkalemia• Peaked, usually narrow, symmetrical T waves• Severe hyperkalemia may present with straight line from tip of S wave (nadir) to peak of T wave, AKA Sine wave.• Sometimes presents with wide complexes, possibly lacking P waves. Z-Fold pattern is common with severe hyperkalemia.• Use medical history to help determine cause.
  • 9. Hyperkalemia Peaked T-Wave• Hyperkalemia = High Potassium Level – Peaked T-Waves • May mimic an acute MI – Sine Waves • Sign of lethally high potassium level Sine Wave
  • 10. Hyperkalemia
  • 11. Hyperkalemia
  • 12. Hyperkalemia
  • 13. Hyperkalemia
  • 14. Osborn Waves Osborn Waves• Sometimes called “J-Waves”• Indicates HYPOTHERMIA• May be associated with bradycardia• Extra wave at the J-Point of the QRS- complex.
  • 15. STE-Mimics• Take a big look at the entire clinical picture.• Often, a pathology has not read up on what it is suppose to look like on an ECG, and breaks all the rules.
  • 16. END• Up next Ischemia, Injury, & Infarct