ECG criteria checker

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  Regional ST elevationSTEMI criteria

  New J-point ST elevation in a coronary territory, usually with reciprocal ST depression in the opposite leads.

  ST-elevation thresholds at the J point

  V2–V3	Men younger than 40	≥2.5 mm
  V2–V3	Men aged 40 and older	≥2 mm
  V2–V3	Women, any age	≥1.5 mm
  All other leads	Everyone	≥1 mm

  Schematic, criteria, and caveatsfor Regional ST elevation
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  Hyperacute T wavesPossible occlusion

  Early change after occlusion: broad, symmetric T waves that are disproportionately large for the QRS.

  Schematic, criteria, and caveatsfor Hyperacute T waves
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  LBBB or paced rhythm with Sgarbossa featuresPossible occlusion

  With left bundle branch block or ventricular pacing, ST changes that are concordant with the QRS, or excessively discordant, suggest acute occlusion.

  Schematic, criteria, and caveatsfor LBBB or paced rhythm with Sgarbossa features
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  de Winter patternPossible occlusion

  Upsloping ST depression into tall, symmetric T waves across the precordial leads, instead of ST elevation.

  Schematic, criteria, and caveatsfor de Winter pattern
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  Posterior MIPossible occlusion

  Anterior ST depression with a dominant R wave is the mirror image of posterior ST elevation, confirmed in leads V7–V9.

  Schematic, criteria, and caveatsfor Posterior MI
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  Right ventricular MIPossible occlusion

  ST elevation in the right-sided precordial leads, often with ST elevation in aVR.

  Schematic, criteria, and caveatsfor Right ventricular MI
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  Aslanger patternPossible occlusion

  ST elevation confined to lead III (not the other inferior leads), with ST depression laterally.

  Schematic, criteria, and caveatsfor Aslanger pattern
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  South African flag signPossible occlusion

  High lateral ST elevation (leads I, aVL, and V2) with reciprocal ST depression in lead III.

  Schematic, criteria, and caveatsfor South African flag sign
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  Diffuse ST depression with ST elevation in aVRPossible occlusion

  Global ischemic changes that may reflect left main or balanced three-vessel disease.

  Schematic, criteria, and caveatsfor Diffuse ST depression with ST elevation in aVR
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  Wellens syndromeUrgent

  Biphasic or deeply inverted T waves in V2–V3, seen in a pain-free interval.

  Schematic, criteria, and caveatsfor Wellens syndrome
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  New or presumed-new bundle branch blockUrgent

  A new left or right bundle branch block in a patient with ischemic symptoms.

  Schematic, criteria, and caveatsfor New or presumed-new bundle branch block
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  ST depression

  New horizontal or downsloping ST depression in two or more contiguous leads: suggestive of myocardial ischemia.

  Schematic, criteria, and caveatsfor ST depression
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  T-wave inversion

  New or dynamic T-wave inversion in two contiguous leads, in leads where the T wave is normally upright.

  Schematic, criteria, and caveatsfor T-wave inversion
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  Completed infarction (late presentation)

  Loss of R waves or new Q waves with persistent ST elevation and/or T-wave inversion.

  Schematic, criteria, and caveatsfor Completed infarction (late presentation)
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  None of the above

  I looked at the ECG and see none of these patterns. The schematic is a normal ECG, for comparison. This records ST elevation and new ischemic ECG changes as absent for the other pages. It does not exclude ACS: repeat the ECG if symptoms persist.

The schematics are original drawings built from the measurements in the criteria, not real tracings. They are stored in public/figures/ecg and can be replaced. Always interpret the actual ECG in clinical context and compare with a prior tracing.