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Occlusion Myocardial Infarction represents a shift away from the traditional STEMI framework.  Reliance on classic STEMI criteria alone will miss 25% of patients who would benefit from immediate reperfusion therapy. Here are some ECG patterns to recognize.

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1) South African Flag Pattern: ST elevation localized to leads I and aVL, +- V2, with reciprocal ST depression in lead III 🡪 consider occlusion of the first diagonal branch of the LAD.

 

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2) De Winter T Waves:  Tall, symmetric T waves in V1–V6 with ST depression at the J point 🡪 proximal LAD occlusion.

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3) Hyperacute T Waves: Look for broad and asymmetric T waves, often contiguous, frequently appearing before the development of ST elevation in AMI

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4) Isolated Posterior MI Pattern:  ST depression in V1–V3 with upright T waves. When the ECG is inverted, these changes resemble an anterior STEMI. Get a 15-lead, looking for ST elevation in the posterior leads 🡪 right coronary artery or less commonly left circumflex artery occlusion.

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5) Wellens’ Syndrome: Look for biphasic T waves or deeply inverted T waves in leads V2–V3, typically occurring after resolution of chest pain 🡪 proximal LAD stenosis.