ST segment elevation

Background

• Its presence must be explained (there is no "nonspecific ST elevation")
• Not a specific marker for STEMI

DDX

1. Myocardial Ischemia
   1. ATEMI
   2. Wellens' Syndrome
   3. Ventricular aneurysm
   4. Coronary spasm
2. Pericarditis
3. Early repolarization
4. LBBB
5. LVH
6. Misc
   1. Meds: TCA, digoxin
   2. Pacing
      1. RV pacing = LBBB
   3. Hyperkalemia
   4. Hypothermia
      1. "Osborn J waves"
   5. Brugada Syndrome

Early Repolarization versus STEMI

• Early Repolarization
  • 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

See Sgarbossa's Criteria