Elevation criteria for low lateral STEMI.

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asked 1 month ago

According to our guidelines in the ALS for STEMI diagnosis, we are required to identify 1mm of elevation in 2 or more contiguous leads to diagnose a STEMI unless those leads are in V1-V3, therefore including V4 as well. However, the wording does not include lateral leads V5 and V6. For diagnostic criteria in these leads specifically, how many mm of elevation are required when isolated for the high lateral leads? Also, what is the recommendation for elevation criteria in posterior leads? >.5mm or >1mm?

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answered 2 weeks ago

Thank you for your question. The leading cardiology associations define ECG STEMI criteria by the Universal Definition of Myocardial Infarction , which includes:

New ST elevation in V2-V3 of at least: 2mm in men or 1.5 mm in women, OR

New ST elevation of at least 1 mm in two contiguous leads (except for V2 or V3)

The reason V2 and V3 have different criteria is because the amplitude of the QRS tends to be higher in these leads, often leading to some ST elevation and the prevalence of concave ST segments in these leads. So to answer your question, leads V5, V6 or Posterior leads would only require 1mm or greater of ST elevation.