ECG – BER vs STEMI

This is the ECG of a 42 year old male who presented with central chest pain.

Describe and interpret the ECG, and plan further management.

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• Sinus rhythm
• 60bpm
• Normal axis
• Normal conduction intervals
• Normal QRS
• No hypertrophy
• 2mm ST elevation in V2 and V3, no reciprocal changes
• Pronounced ?hyperacute T waves V2 and V3

So is this benign early repolarisation or anterior STEMI?

This can certainly be tricky! Old ECGs are useful, as are serial ECGs and a troponin, but there is also a formula by the excellent Dr Smith which although fiddly, can be useful to nudge us in the right direction with these subtle but critical cases.

In this case the Subtle Anterior Stemi Calculator gives us 19.6 points (above the 18.2 cut off) = likely anterior STEMI.

This patient had a raised troponin, cath lab was activated and they were found to have near total LAD occlusion

For more info on subtle anterior STEMI follow the links below:

• Dr Smith’s ECG Blog
• Emergency Medicine Cases BER vs Anterior STEMI