Subtle Anterior STEMI Calculator
Differentiates early repolarization from anterior STEMI.
NOTE: Cannot be used with LVH or bundle branch block. Not to be used for obvious anterior STEMI.
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- ST elevation at 60 ms after the J-point in lead V3, relative to the PR segment
- Find the J-point (lower blue arrow)
- Locate the time point of that J-point (left-hand green arrow)
- Go 60 ms to the right (right hand green arrow)
- Go up to the tracing (upper blue arrow)
- Draw a horizontal line at this point (upper green line)
- Draw a horizontal line at the level of the PR interval (lower green line)
- Measure the voltage between these two lines (in this case, 3.5 mm or 0.35 mV)
- R-wave amplitude in lead V4
- Mark the level of the PR interval (lower green line)
- Mark the top of the R-wave (upper green line)
- Measure the distance between the two: (17 mm of grid lines plus + 7.5 mm off the grid, Total = 24.5 mm
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- Stephen Smith, MD