STEMI or NSTEMI ? During an outing in SMUR (medical ambulance with a doctor on board because in my country we practice "stay and play" and not "scoop and run" in emergency medicine) a student nurse friend of mine sent me the ECG of the patient. The patient had a ST segment sub-shift compatible with NSTEMI, it was not a mirror image of a STEMI, there was no ST elevation. However, there was a de novo LBBB. Now, in class, we were taught that a de novo LBBB should be considered as a STEMI provided that there was a compatible symptomatology. I know that it is more complicated than that in reality, that there are criteria and scores to say whether or not this LBBB is in fact a STEMI or not, but I remind you that we are in an emergency medicine context, we don't have time to take out our ruler and measure all the indices. So my question is, in this situation, i.e. de novo LBBB and significant ST segment sub-shift, should we manage this patient as a STEMI or as a NSTEMI?
