Date Published

August 5, 2021

Updated For

ALS PCS Version ALS PCS Version 5.2


My question is regarding STEMI bypass and hyperacute T Waves. We were called out for a 60's male patient experiencing chest pain after some physical exercise. It was quite apparent patient was likely having a cardiac event upon arrival and first examination. Patient had 8/10 midsternal pain (pressure) with radiation into shoulders. Patient was clammy, cool and diaphoretic. Patient had a weak radial pulse. After giving ASA 12 leads were obtained. Each showing hyperacute T waves in the chest lead V2 - V5. No elevation is noted, upon multiple 12 leads. No nitro was given as heart rate was below 60, but a lock was established. Patient was stable and wouldn't have any of the contraindication to STEMI bypass. We are a rural service and closest hospital is 7 minutes away and transport time to the cath lab would be roughly 25 minutes. Just curious how base hospital would like us to proceed on these calls in the future? a - go directly to closest hospital as there is no elevation yet and doesn't quite meet STEMI bypass b- call the closest cath lab and let the cardiologist decide c- first call base hospital to ask for further direction to see if cath lab should be called, then proceed from there. Thanks in advance


a - go directly to closest hospital as there is no elevation yet and doesn't quite meet STEMI bypass.

Since the patient does not have a 12-Lead ECG meeting STEMI criteria, the patient should be treated with the Cardiac Ischemia Medical Directive and taken to the closest hospital.


You are correct that hyperacute T waves may represent ischemia and should serial ECGs show STEMI, the patient can be considered for Bypass.  However, without the STEMI finding, an emergent cardiac catheterization is not indicated and would not be performed.  Therefore, the patient can be managed equally well at the closest ED and should be transported there. There can be other causes of hyperacute T waves (or peaked T waves that may be mistaken for hyperacute T waves) that warrant ED investigation.



Cardiac Ischemia, STEMI

Additional Resources

No additional resources are available for this SWORBHP Tip.