What can mimic ST elevation?

What can mimic ST elevation?

Summary: Both pneumomedisitinum and pneumothorax may present with acute chest pain and ECG findings that mimic, to some degree, that of a STEMI. Each should be included in the differential, especially in those patients at risk….

• Cocaine & Chest Pain.
• Aortic Dissection.
• Pericarditis.
• Pneumomediastinum.
• Pneumothorax.

What can ST segment elevation indicate?

The leads facing the injured cardiac muscle cells will record the action potential as ST elevation during systole while during diastole, there will be depression of the PR segment and the PT segment. Since PR and PT interval are regarded as baseline, ST segment elevation is regarded as a sign of myocardial ischemia.

What mimics myocardial infarction?

Pneumonia is another condition known to mimic myocardial infarction. A mediastinal tumour may lead to compression of coronary, myocardial and/or pericardial structures.

Why does infarction cause ST elevation?

Accordingly, ST segment elevation during acute myocardial infarction requires the injury current to flow in the opposite direction [12, 13, 24], which can be caused by greater depression of the epicardial action potential.

What is the most common STEMI mimic?

STEMI mimics

• 3.1 Electrolytes (Hyperkalemia)
• 3.2 Left Bundle Branch Block.
• 3.3 Early Repolarization.
• 3.4 Ventricular Hypertrophy (Left Ventricular Hypertrophy)
• 3.5 Aneurysm (Ventricular Aneurysm)
• 3.6 Thailand (Brugada Syndrome)
• 3.7 Inflammation (Pericarditis)
• 3.8 Osborn (J) wave.

What causes ST elevation in myocardial infarction?

An acute ST-elevation myocardial infarction occurs due to occlusion of one or more coronary arteries, causing transmural myocardial ischemia which in turn results in myocardial injury or necrosis.

What is a STEMI mimic?

A STEMI mimic is defined as an activation of the STEMI pathway with ST segment elevation on a 12 lead ECG without angiographic evidence of occlusive coronary artery disease, or an acute MI being ruled out on clinical or biochemical grounds.

What is elevated in myocardial infarction?

Troponins are the most widely recognized and important cardiac enzymes used in the diagnosis of acute myocardial ischemia in modern medicine. The majority of patients with an acute MI will have elevation in troponins within 2 to 3 hours of arrival at the emergency department, versus 6 to 12 hours with creatine kinase.

What causes ST segment elevation?

The ST Segment represents the interval between ventricular depolarization and repolarization. The most important cause of ST segment abnormality (elevation or depression) is myocardial ischaemia or infarction. Acute STEMI may produce ST elevation with either concave, convex or obliquely straight morphology.

What is the difference between ST segment elevations and St ischemia?

ST segment elevations with straight (horizontal, upsloping, or downsloping) or convex ST segment strongly suggest acute transmural ischemia ( Figure 1 A ). Concave ST segment elevations, on the other hand, are much less likely to be caused by ischemia ( Figure 1 B ). This is noted in both North American and European guidelines.

What are the patterns of ST elevation?

Patterns of ST Elevation 1 Acute ST elevation myocardial infarction (STEMI) ST segment elevation and Q-wave formation in contiguous leads. 2 Coronary Vasospasm (Prinzmetal’s angina) This causes a pattern of ST elevation that is very similar to acute STEMI — i.e. 3 Pericarditis. 4 Benign Early Repolarization.

Is ST segment elevation a sign of acute myocardial infarction?

One common axiom in emergency medicine is that ST segment elevation in an emergency department (ED) patient with chest pain should be assumed to be an acute myocardial infarction (AMI) until proven otherwise. Like many axioms in emergency medicine, it embodies an “assume the worst and rule it out” approach to evaluating acute symptoms.