STEMI Equivalents: Wellens, de Winter, aVR, Posterior, Sgarbossa & RV Infarct | EM Board Review

Eight ECG patterns that mean acute occlusion without meeting the millimeter STEMI rule. Wellens, de Winter, hyperacute T waves, aVR ST elevation, posterior MI, V4R for right ventricular infarction, Sgarbossa criteria for LBBB and paced rhythms, and the South African Flag sign. Real ECG strips, pattern-recognition framework, and the board traps that get residents burned. Presented by Ezekiel Shepard, M.D. Shepard EM Board Review — high-yield emergency medicine education for board exams, shift performance, and clinical reasoning. ⏱ CHAPTERS 0:00 STEMI Equivalents 0:03 Title 0:32 Objectives 1:21 Why STEMI Equivalents Matter 2:00 The Eight STEMI-Equivalent Patterns 2:55 Wellens Syndrome — The Pattern 3:43 Wellens — Type A vs Type B 4:15 Wellens — Pathophys and Pseudonormalization 4:53 Wellens — Do Not Stress Test 5:30 de Winter T Waves — The Pattern 6:08 de Winter — Pathophys and Recognition 6:42 Wellens vs de Winter 7:22 Hyperacute T Waves — The Earliest Sign 8:01 Hyperacute T vs Hyperkalemia 8:43 aVR ST Elevation — The Pattern 9:28 aVR — Left Main and Triple-Vessel 10:10 aVR Differential — Do Not Get Burned 10:50 Posterior STEMI — 12-Lead Clues 11:37 Posterior Leads V7 through V9 12:18 Right Ventricular Infarct — V4R 13:03 RV Infarct — Management Rules 13:45 Sgarbossa Criteria — LBBB and Paced 14:29 Smith-Modified Sgarbossa 15:15 Isolated High Lateral — South African Flag 16:00 STEMI Equivalent Recognition Algorithm 16:47 Board Traps in STEMI Equivalents 17:33 Case 1 — Pain-Free with Biphasic T Waves 18:12 Case 2 — Diffuse Depression with aVR Elevation 18:55 Case 3 — Inferior STEMI with Hypotension 19:41 Board Question 1 20:20 Board Question 2 21:02 Board Question 3 21:36 Final Takeaways 📚 ABOUT THIS SERIES Shepard EM Board Review delivers polished, board-relevant emergency medicine lectures for residents, attendings, and students preparing for boards or sharpening on-shift clinical reasoning. Each lecture covers a focused high-yield topic with specific dosing anchors, treatment-sequence framing, and the classic board traps. 🎓 REFERENCES & ACKNOWLEDGEMENTS Content informed by Rosen's Emergency Medicine (10th edition), Foundations of EM Board Review, and current society guidelines (ACEP, AHA/ACC). ECG strips used in this lecture sourced from Wikimedia Commons under CC BY-SA with attribution. Pattern references from LITFL ECG Library — litfl.com. ⚠ DISCLAIMER This content is for educational purposes only. It does not replace clinical judgment, institutional protocols, or specialty consultation. Always follow your local guidelines and consult appropriate specialists. 💬 Comment with topics you want covered next. 👍 Like and subscribe for more high-yield emergency medicine board content. #EmergencyMedicine #BoardReview #STEMI #ECG #ShepardEMBoardReview