Which finding on telemetry would most strongly suggest a STEMI?

Which finding on telemetry would most strongly suggest a STEMI?

• A. ST elevation in contiguous leads
• B. ST depression in limb leads
• C. T-wave inversion in aVL
• D. Peaked T waves

Answer: (A)

ST-segment elevation in multiple, neighboring leads is the clearest sign of a STEMI. This pattern shows that a region of the heart is under full-thickness (transmural) ischemia due to acute coronary occlusion. Leads that are next to each other view the same myocardial territory, so when their ST segments elevate together, it points to a regional infarction and the need for immediate reperfusion therapy. Other changes fit less well with a STEMI. ST depression in limb leads often reflects subendocardial ischemia or reciprocal changes rather than transmural injury. T-wave inversion in aVL is a non-specific repolarization change that can occur with various conditions, not definite for STEMI. Peaked T waves are characteristic of hyperkalemia, not infarction.

ST-segment elevation in multiple, neighboring leads is the clearest sign of a STEMI. This pattern shows that a region of the heart is under full-thickness (transmural) ischemia due to acute coronary occlusion. Leads that are next to each other view the same myocardial territory, so when their ST segments elevate together, it points to a regional infarction and the need for immediate reperfusion therapy.

Other changes fit less well with a STEMI. ST depression in limb leads often reflects subendocardial ischemia or reciprocal changes rather than transmural injury. T-wave inversion in aVL is a non-specific repolarization change that can occur with various conditions, not definite for STEMI. Peaked T waves are characteristic of hyperkalemia, not infarction.