ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction

Abstract

cute myocardial infarction resulting from an occlusive thrombus is recognized on an electrocardiogram by ST-segment elevation. 1 Early reperfusion therapy has proved beneficial in such infarctions. 2-4 The earlier the reperfusion, the greater the benefit, and the time to treatment is now considered to indicate the quality of care. These days, when thrombolytic treatment and percutaneous intervention are carried out so readily, it is important to remember that acute infarction is not the only cause of ST-segment elevation. The purpose of this review is to describe other conditions that mimic infarction and emphasize the electrocardiographic clues that can be used to differentiate them from true infarction.

Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention

“…8,10,11,18,19 Costantini and colleagues 19 reported that myocarditis patients are generally young males with a low coronary risk profile. In agreement, (myo)-pericarditis was found in five patients in our group who were all male, with an age ranging from 31 to 67, and none of them had more than two cardiovascular risk factors (table 3A).…”

“…8 First, transient ST-segment elevation can be present in acute coronary syndromes, especially in patients with significant coronary artery stenosis but no total occlusion. 9 Second, cardiac conditions not affecting the coronary arteries, such as pericarditis and myocarditis, can also present in an infarction-like manner.…”

“…9 Second, cardiac conditions not affecting the coronary arteries, such as pericarditis and myocarditis, can also present in an infarction-like manner. 8,10,11 A third group of conditions which sometimes have a STEMI-like presentation are of vascular origin, such as pulmonary embolism and aortic dissection. 12,13 Finally, noncardiac conditions such as acute cholecystitis or pancreatitis may also mimic STEMI.…”

84-Year-Old Woman With Chest Pain

“…These conditions include early repolarization, hyperkalemia, acute pericarditis, left ventricular hypertrophy, left bundle branch block, pulmonary embolism, coronary vasospasm (Prinzmetal angina), Brugada syndrome, and immediate postcardioversion changes. 1 Appropriate triage should always begin with a thorough history and physical examination. In a stable patient, more time may be available for a complete examination.…”

“…These characteristics and the absence of reciprocal ST depression are more consistent with acute pericarditis than AMI. 1 The history of recently untreated rheumatoid arthritis further supported this notion. 2 In the triage of patients with chest pain, lifethreatening emergencies should first be considered.…”