ST segment elevation: Difference between revisions
m (moved ST Segment Elevation to ST Segment Elevation (DDX)) |
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==DDX== | ==DDX== | ||
#Myocardial Ischemia | #Myocardial Ischemia | ||
## | ##STEMI | ||
##Wellens' Syndrome | ##Wellens' Syndrome | ||
##Ventricular aneurysm | ##Ventricular aneurysm | ||
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#Misc | #Misc | ||
##Meds: TCA, digoxin | ##Meds: TCA, digoxin | ||
##RV pacing (appears as LBBB) | |||
##Hyperkalemia | ##Hyperkalemia | ||
##Hypothermia | ##Hypothermia | ||
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==Early Repolarization versus STEMI== | ==Early Repolarization versus STEMI== | ||
*Early Repolarization | *Early Repolarization suggested by: | ||
**ST elevation <4mm | **ST elevation <4mm | ||
**Notched J point | **Notched J point | ||
Revision as of 00:57, 2 March 2012
Background
- Its presence must be explained (there is no "nonspecific ST elevation")
- Not a specific marker for STEMI
DDX
- Myocardial Ischemia
- STEMI
- Wellens' Syndrome
- Ventricular aneurysm
- Coronary spasm
- Pericarditis
- Early repolarization
- LBBB
- LVH
- Misc
- Meds: TCA, digoxin
- RV pacing (appears as LBBB)
- Hyperkalemia
- Hypothermia
- "Osborn J waves"
- Brugada Syndrome
Early Repolarization versus STEMI
- Early Repolarization suggested by:
- ST elevation <4mm
- Notched J point
- Concave or saddle-back ST morphology
- No reciprocal changes
LVH versus STEMI
- Difficult to exclude MI in pt with LVH (pt already at risk for MI)
- Best aid is prior ECG or serial ECGs
LBBB versus STEMI
STEMI
- ST elevation in those leads that reflect the distribution of a single coronary artery
- RCA: II, III, aVF (inferior)
- LAD: V1-V4 (antero-septal)
- Circumflex: V5-V6, I, aVL (lateral)
- Dominant left circulation: infero-lateral
- ST morphology
- Concave up versus convex
- Convex has Sp 97%, Sn 77%
- Concave up versus convex
- Look for reciprocal ST depression
- 35% of anterior STEMI have ST depression in inferior leads
- 80% of inferior STEMI have ST depression in anterior leads
- However, may represent reciprocal changes OR posterior STEMI
Source
- ST Elevation Lecture, Dr. Niemann, Harbor-UCLA