Managing STEMI Mimics in the Prehospital Environment

This is a PowerPoint presentation developed as continuing education material for EMS providers, primarily at the ALS (paramedic) level of care. The topic is one that I think is important, the recognition and appropriate management of “STEMI mimics”—pathologies or disorders that are non-ischemic in nature, but are associated with signs/symptoms and especially with ECG changes characteristic of acute MI, such as ST segment elevation. The main theme here is the understanding that many, or even most instances of ST elevation are not true STEMI, but unrelated disorders, some of which are benign and some of which are critical, but all of which demand different treatment than the ACS patient. In short, recognizing the presence of ST elevation is generally not difficult; categorizing it into MI and non-MI causes, however, is both difficult and essential for effective prehospital care.

At this time I do not actually teach any con ed courses, so this was developed as standalone material, and is freely available for any instructors who are interested in using it. It is not currently approved for recertification credit by the National Registry or any individual state; obtaining such credit is your responsibility. Any instructor with an appropriate understanding of the subject matter should be able to teach it. The illustrative ECGs included are marked up with comments in the PowerPoint notes.

This material is fairly comprehensive, but is intended as a practical guide for field assessment and treatment of the pathologies discussed, rather than an in-depth examination of their etiologies and courses of care. Sources for most of the contentious claims and data are listed on the slides; sources for the more everyday material are available by request.

There are 192 slides in the full presentation; the most common feedback is that this can make for a very dense and potentially drawn-out class. There is one natural “intermission” point for a break at about the halfway mark, between the introductory discussion on general ideas and before diving into specific and individual mimics. If desired, the course can be broken up further into multiple units or even multiple days.


I've also developed this material into a narrated video lecture for EMS Basics.