ST Elevation without Infarction

Author: Leilah J Dare / Editor: Jason M Kendall / Reviewer: Joe Schrieber, Peter Lynas / Code: A1 / Published: 05/04/2023

This session is largely concerned with the cardiac causes of ST segment elevation unrelated to acute myocardial infarction (AMI). It also investigates the non-cardiac causes which might present with a similar ECG to AMI (e.g. subarachnoid haemorrhage or pulmonary embolism) or which might complicate AMI (e.g. hyperkalaemia).

Prerequisites:

Before commencing this session you should be able to interpret ECG’s and have completed the following Module sessions:

  • Acute Coronary Syndromes: Pathophysiology and Presentation
  • Chest Pain Syndromes

After completing this session you will be able to:

  • List the principle causes of ST Segment elevation which are not due to myocardial infarction
  • Perform a detailed interpretation of an ECG with ST Segment elevation
  • Distinguish between the different causes of ST Segment elevation based on ECG findings
  • Relate the ECG to clinical findings in order to achieve a diagnosis.
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References:

  1. Otto LA, Aufderheide TP. Evaluation of ST segment elevation criteria for the prehospital electrocardiographic diagnosis fo acute myocardial infarction. Ann Emerg Med. 1994 Jan;23(1):17-24.
  2. Turnipseed SD, Bair AE, Kirk JD, et al. Electrocardiogram differentiation of benign early repolarization versus acute myocardial infarction by emergency physicians and cardiologists. Acad Emerg Med. 2006 Sep;13(9):961-6.
  3. Mehta MC, Jain AC. Early repolarization on scalar electrocardiogram. Am J Med Sci. 1995 Jun;309(6):305-11. doi: 10.1097/00000441-199506000-00001.
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  6. Brady WJ, Syverud SA, Beagle C, Perron AD, et al. Electrocardiographic ST-segment elevation: the diagnosis of acute myocardial infarction by morphologic analysis of the ST segment. Acad Emerg Med. 2001 Oct;8(10):961-7.
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  10. Wang K, Asinger RW, Marriott HJ. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med. 2003 Nov 27;349(22):2128-35.
  11. Mehta M, Jain AC, Mehta A. Early repolarization. Clin Cardiol. 1999 Feb;22(2):59-65.
  12. Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med. 2004 Nov 18;351(21):2195-202.
  13. Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, et al. Proposed diagnostic criteria for the Brugada syndrome: consensus report. Circulation. 2002 Nov 5;106(19):2514-9.
  14. Brady, William J. MD; Harrigan, et al. Diagnosis: Left Ventricular Aneurysm. Emergency Medicine News 28(6):p 38, June 2006.
  15. Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med. 1996 Feb 22;334(8):481-7.
  16. Sreeram N, Cheriex EC, Smeets JL, Gorgels AP, Wellens HJ. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. Am J Cardiol. 1994 Feb 1;73(4):298-303.
  17. Geibel A, Zehender M, Kasper w, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. European Respiratory Journal; 2005. 25: pp.843-848.
  18. Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999 Jan;44(1):34-9; discussion 39-40.
  19. Cheng TO. Pseudoinfarctions. Circulation; 2001. 103; pp.e68.
  20. Batty R, Straiton J. Brain Abscess, Epidural Abscess, Subdural Empyaema. Radiology – Integrated Training Initiative 2006: e-learning session 6b_129. Royal College of Radiologists, London.

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