There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
STEMI Diagnosis with Deep S Wave
- A patient can have an ST-Elevation Myocardial Infarction (STEMI) with a deep S wave, but the diagnosis may be challenging due to various electrocardiographic (ECG) patterns that can mimic STEMI 1, 2.
- The presence of a deep S wave can be associated with STEMI, but it can also be seen in other conditions, such as left bundle branch block or left ventricular hypertrophy, which can make it difficult to diagnose STEMI 1, 3.
ECG Machine Indications
- An ECG machine may indicate that it is not a STEMI due to various reasons, including:
- STEMI mimics, such as benign early repolarization, acute pericarditis, or left ventricular aneurysm, which can cause ST-segment elevation similar to STEMI 1, 2.
- STEMI confounders, such as left bundle branch block or left ventricular hypertrophy, which can make it difficult to interpret the ECG and diagnose STEMI 1.
- Non-ischemic ST-segment elevation, which can be caused by conditions other than acute coronary artery thrombosis, such as ventricular paced pattern or Wolff-Parkinson-White syndrome 4.
Diagnostic Challenges
- The diagnosis of STEMI can be challenging due to the presence of various ECG patterns that can mimic STEMI, and the need for rapid and accurate interpretation of the ECG to activate the primary percutaneous coronary intervention (pPCI) protocol 1, 4.
- The use of advanced ECG interpretation, complementary bedside echocardiography, and advanced imaging can help improve the diagnosis of STEMI and distinguish it from other conditions 5.