What are appropriate questions to ask an instructor during a class on ST-Elevation Myocardial Infarction (STEMI) electrocardiogram (ECG) interpretation?

From the Guidelines

During a STEMI ECG class, good questions to ask your instructor include: "What are the most commonly missed STEMI patterns?" and "What ECG findings differentiate between STEMI mimics and true STEMIs?" You should also ask about specific criteria for diagnosing STEMIs in special circumstances like left bundle branch block (using Sgarbossa criteria) or right ventricular infarction, as outlined in the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1. Ask about the timing of ECG changes in relation to symptom onset and how to recognize subtle ST elevation in specific territories like the posterior or lateral walls. Request clarification on the differences between ST elevation caused by early repolarization versus true ischemia, and how to interpret ST depression in the context of possible posterior MI, considering the European Society of Cardiology guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation 1. Questions about how to approach ECG interpretation systematically and what additional views might be helpful when standard leads are inconclusive would also be valuable, taking into account the recommendations from the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1. These questions will help you develop critical thinking skills for rapid STEMI recognition in clinical practice, where timely identification directly impacts patient outcomes through faster reperfusion therapy, as emphasized in the ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction 1.

Some key points to discuss with your instructor include:

• The importance of early ECG interpretation and the role of computer-assisted ECG interpretation in diagnosing STEMI 1
• The criteria for diagnosing STEMI in special circumstances, such as left bundle branch block or right ventricular infarction 1
• The differences between ST elevation caused by early repolarization versus true ischemia, and how to interpret ST depression in the context of possible posterior MI 1
• The role of additional views, such as right-sided ECG leads, in diagnosing STEMI 1
• The importance of systematic ECG interpretation and the use of quality indicators to measure and improve STEMI care 1

From the Research

Appropriate Questions to Ask an Instructor

When attending a class on ST-Elevation Myocardial Infarction (STEMI) electrocardiogram (ECG) interpretation, it is essential to ask questions that clarify the concepts and techniques involved in diagnosing and managing STEMI. Some appropriate questions to ask an instructor include:

• What are the key features to look for on an ECG to diagnose STEMI, and how can they be distinguished from other conditions that may mimic STEMI 2?
• How can ECG indices of myocardial ischemia be used for risk stratification and decision making of reperfusion strategies in STEMI patients 3?
• What are the challenges of diagnosing and treating in-hospital STEMI, and how can quality improvement programs be implemented to improve treatment and outcomes 4?
• How can a 4-step algorithm be used to diagnose STEMI in adult patients with chest pain or equivalent presentation, and what are the limitations of this approach 2?
• What is the role of primary percutaneous coronary intervention (PCI) in the treatment of STEMI, and what are the alternatives if PCI cannot be performed within 120 minutes of STEMI diagnosis 5, 6?

ECG Interpretation and STEMI Diagnosis

When asking questions about ECG interpretation and STEMI diagnosis, consider the following topics:

• The importance of early diagnosis and immediate reperfusion in limiting myocardial ischemia and infarct size 5
• The use of ECG-derived parameters to assess microvascular obstruction (MVO) and their prognostic relevance 6
• The challenges of interpreting ECGs in patients with in-hospital STEMI, including delays in electrocardiogram acquisition and interpretation 4

Reperfusion Strategies and Treatment

When asking questions about reperfusion strategies and treatment, consider the following topics:

• The role of primary PCI in the treatment of STEMI, and the alternatives if PCI cannot be performed within 120 minutes of STEMI diagnosis 5, 6
• The use of fibrinolysis therapy to dissolve the occluding thrombus if PCI cannot be performed within 120 minutes of STEMI diagnosis 5
• The importance of quality improvement programs in improving treatment and outcomes for patients with in-hospital STEMI 4