ST segment elevation: Difference between revisions
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*Not a specific marker for STEMI | *Not a specific marker for STEMI | ||
== | ==Differential Diagnosis== | ||
#Myocardial Infarct ([[STEMI]]) | #Myocardial Infarct ([[STEMI]]) | ||
#[[Wellens' Syndrome]] | #[[Wellens' Syndrome]] | ||
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#LV aneurysm | #LV aneurysm | ||
#Early repolarization | #Early repolarization | ||
#LBBB | #[[LBBB]] | ||
#LVH | #[[LVH]] | ||
#Misc | #Misc | ||
##Meds: TCA, digoxin | ##Meds: TCA, digoxin | ||
##RV pacing (appears as LBBB) | ##RV pacing (appears as LBBB) | ||
##Hyperkalemia | ##[[Hyperkalemia]] | ||
##Hypothermia | ##[[Hypothermia]] | ||
###"Osborn J waves" | ###"Osborn J waves" | ||
##[[Brugada Syndrome]] | ##[[Brugada Syndrome]] | ||
==Early Repolarization versus STEMI== | ==Diagnosis== | ||
===Early Repolarization versus STEMI=== | |||
*Early Repolarization suggested by: | *Early Repolarization suggested by: | ||
**ST elevation <4mm | **ST elevation <4mm | ||
| Line 28: | Line 29: | ||
**No reciprocal changes | **No reciprocal changes | ||
==LVH versus STEMI== | ===LVH versus STEMI=== | ||
*Difficult to exclude MI in pt with LVH (pt already at risk for MI) | *Difficult to exclude MI in pt with LVH (pt already at risk for MI) | ||
*Best aid is prior ECG or serial ECGs | *Best aid is prior ECG or serial ECGs | ||
==LBBB versus STEMI== | ===LBBB versus STEMI=== | ||
See [[Sgarbossa's Criteria]] | See [[Sgarbossa's Criteria]] | ||
==[[STEMI]]== | ===[[STEMI]]=== | ||
*ST elevation in those leads that reflect the distribution of a single coronary artery | *ST elevation in those leads that reflect the distribution of a single coronary artery | ||
**RCA: II, III, aVF (inferior) | **RCA: II, III, aVF (inferior) | ||
Revision as of 04:28, 28 November 2014
Background
- Its presence must be explained (there is no "nonspecific ST elevation")
- Not a specific marker for STEMI
Differential Diagnosis
- Myocardial Infarct (STEMI)
- Wellens' Syndrome
- Coronary spasm (eg, Prinzmetal's angina)
- Drugs (eg, cocaine, crack, meth)
- Pericarditis
- LV aneurysm
- Early repolarization
- LBBB
- LVH
- Misc
- Meds: TCA, digoxin
- RV pacing (appears as LBBB)
- Hyperkalemia
- Hypothermia
- "Osborn J waves"
- Brugada Syndrome
Diagnosis
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
See Also
Source
- ST Elevation Lecture, Dr. Niemann, Harbor-UCLA