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Review
. 2013 Jul-Aug;65(4):412-23.
doi: 10.1016/j.ihj.2013.06.013.

ST segment elevations: always a marker of acute myocardial infarction?

G Coppola  1 , P Carità, E Corrado, A Borrelli, A Rotolo, M Guglielmo, C Nugara, L Ajello, M Santomauro, S Novo; Italian Study Group of Cardiovascular Emergencies of the Italian Society of Cardiology
Affiliations
Review

ST segment elevations: always a marker of acute myocardial infarction?

G Coppola et al. Indian Heart J. 2013 Jul-Aug.

Abstract

Chest pain is one of the chief presenting complaints among patients attending Emergency department. The diagnosis of acute myocardial infarction may be a challenge. Various tools such as anamnesis, blood sample (with evaluation of markers of myocardial necrosis), ultrasound techniques and coronary computed tomography could be useful. However, the interpretation of electrocardiograms of these patients may be a real concern. The earliest manifestations of myocardial ischemia typically interest T waves and ST segment. Despite the high sensitivity, ST segment deviation has however poor specificity since it may be observed in many other cardiac and non-cardiac conditions. Therefore, when ST-T abnormalities are detected the physicians should take into account many other parameters (such as risk factors, symptoms and anamnesis) and all the other differential diagnoses. The aim of our review is to overview of the main conditions that may mimic a ST segment Elevation Myocardial Infarction (STEMI).

Keywords: Chest pain; Differential diagnosis; ECG; Myocardial infarction; ST segment.

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Figures

Fig. 1
Fig. 1
Hypertrophic cardiomyopathy.
Fig. 2
Fig. 2
Atrial Flutter 2:1(a) after a DC shock (b).
Fig. 3
Fig. 3
Acute pericarditis.
Fig. 4
Fig. 4
ECG of a young patient presenting with acute ischemic-like chest pain and normal coronary arteries. The magnetic resonance confirmed the presence of myocarditis.
Fig. 5
Fig. 5
Transient elevation of ST segment in inferior leads in patients symptomatic for chest pain and histamine fish poisoning.
Fig. 6
Fig. 6
Transient elevation of ST segment in inferior leads in patients symptomatic for chest pain who was going to be transferred in the surgery room for an orthopedic intervention.
Fig. 7
Fig. 7
ECG at admission (up) and at discharge (down) of patients with Takotsubo cardiomyopathy.
Fig. 8
Fig. 8
Brugada syndrome (type I).
Fig. 9
Fig. 9
Arrhythmogenic right ventricular cardiomyopathy/dysplasia.
Fig. 10
Fig. 10
Pulmonary thromboembolism.
Fig. 11
Fig. 11
Hyperkalemia.
Fig. 12
Fig. 12
Elevation of ST segment during treatment with clozapine.
Fig. 13
Fig. 13
ECG during acute subarachnoid hemorrhage.
See this image and copyright information in PMC

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