ST Segment and T Wave Abnormalities Not Caused by Acute Coronary Syndromes

Abstract

The evaluation of the chest pain patient suspected of acute coronary syndrome (ACS) represents the major indication for electrocardiograph (ECG) performance in the emergency department (ED) and prehospital settings [1]. The ECG demonstrates significant abnormality in a minority of these patients, ranging from minimal nonspecific ST segment/T wave changes to pronounced STE and T wave abnormalities, including the prominent T wave, the inverted T wave, and the nonspecific T wave (Figs. 1 and 2). The ECG syndromes responsible for these various abnormalities include potentially malignant entities, such as ACS and cardiomyopathy, and less concerning patterns, such as benign early repolarization (BER) or ventricular paced rhythms (VPR) [2][3][4].In a study considering all chest pain patients with electrocardiographic ST segment depression (STD), the following clinical syndromes were responsible for the ECG abnormality: ACS, 26%; left ventricular hypertrophy (LVH), 43%; bundle branch block (BBB), 21%; VPR, 5%; left ventricular aneurysm, 3%; and other patterns, 1% [5]. Similarly, STE is a fairly common finding on the ECG of the chest pain patient and frequently does not indicate STE acute myocardial infarction (AMI). One prehospital study of adult chest pain patients revealed that, of patients manifesting STE who met criteria for fibrinolysis, most were not diagnosed with AMI; rather, LVH and left BBB were found more frequently [6]. Furthermore, in two reviews of adult ED chest pain patients with STE on ECG, the ST segment abnormality resulted from AMI in only 15%-31% of these populations; LVH, seen in 28%-30% of these patients, was a frequent cause of this STE. Other findings responsible for this STE included BER, acute

Nonspecific ST-T changes associated with unsatisfactory blood pressure control among adults with hypertension in China

“…It has been suggested that nonspecific ST-T changes might represent subclinical coronary artery disease, early left ventricular hypertrophy, increased left ventricular mass, or autonomic imbalance. [7,19] The aforementioned parameters may increase the risk of unsatisfactory BP control, although further studies are required to clarify this hypothesis.…”

Pseudo-Wellens Syndrome in a Patient with Hypertension and Left Ventricular Hypertrophy

“…The ST-T segment changes seen in LVH are due to repolarization abnormalities of the hypertrophied muscle of the left ventricle [13]. Typical EKG alterations associated with LVH include early repolarization, asymmetric T wave inversion, and poor R wave progression [13].…”

Ventricular fusion mimicking acute inferior myocardial infarction in a patient with a dual-chamber pacemaker

“…Besides AMI and ventricular paced rhythm, ST-segment elevation may be determined by various abnormalities such as acute pericarditis, bundle branch block, benign early repolarization, Brugada syndrome, acute myocarditis, hypothermia, hyperkalemia, myocardial contusion, and pre-excitation syndromes [3].…”

“…In patients with right ventricular paced rhythm, Brady [3] reported that leads with QS complexes demonstrate ST-segment elevation with an upright T wave; this ST-segment elevation is seen in leads II, III, and aVF as well as leads V1-V6, depending on the positioning of the ventricular lead. Leads with a large monophasic R wave demonstrated ST-segment elevation with T wave inversion.…”