STEMI in presence of LVH
Question #5
Does LVH mimic STEMI only because a larger-than-usual repolarization voltage typically follows a larger-than-usual negative QRS deflection? Or can it cause ST elevation by some other mechanism in other leads where we don't have that huge negative QRS we get in, say, V1? So if I have a pt with new onset of chest pain who meets LVH criteria based on their precordial voltages, but they have ST elevation in II, III, and aVF (especially if their inferior QRS complexes are also all upright), can I still STEMI bypass them?
Related: what if a pt were to meet LVH criteria based only on R wave height in aVL, but their precordial lead voltages are normal. Does LVH in this case also cause ST elevation that can mimic an MI, or could I STEMI bypass this patient if they had chest pain and met STEMI criteria?
Answer:
Please note that initiating a STEMI bypass is not an ALS PCS directive, it is located in the BLS PCS and therefore you should obtain direction from your service in addition to CEPCP. With that being said, a good approach to managing this call would be to apply a diagnostic criteria such as Sgarbossa for assessing excessive concordance and for reciprocal changes. If you suspect that the the ST elevation is related to cardiac ischemia vs a conduction delay, early transport to closest ER should be considered with early hospital notification of your findings.
Medical Directive Category
STEMI
Published
23 January 2025
Views
26
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.