Posted by e-Medical PPT Thursday, June 26, 2014

Recognize ST segment elevation in conditions other than acute MI

Unwarranted thrombolytic therapy
Unnecessary emergency angiography
Unnecessary anxiety (for intern)

Normal ST elevation
1 - 3mm elevation in one or more precordial leads in relation to the end of the PR segment (male pattern)
ST segment is concave

Early Repolarization
Most commonly the ST-segment elevation is most marked in V4 with a notch at the J point, and the ST segment is concave
T waves are tall and are not inverted

T-wave Inversion
This normal variant differs from the early-repolarization pattern in that the T waves are inverted and the ST segment tends to be coved
Combination of an early-repolarization pattern and a persistent juvenile T-wave pattern. Often, the findings are so suggestive of acute myocardial infarction that an echocardiogram is necessary to differentiate them, especially if one is not aware of this normal variant. In most cases of this normal variant, the QT interval is short, whereas it is not short in acute infarction or pericarditis.

LV Hypertrophy
Deep S wave
QS pattern in leads V1 through V3
Elevated ST segment is concave in a pt with uncomplicated LV hypertrophy as compared with convex in a pt with acute concomitant MI

Left Bundle Branch Block
Making the dx of acute infarction in the presence of LBBB can be problematic, since the ST segment is either elevated or depressed secondarily, simulating or masking an infarction pattern
Sgarbossa’s criteria is controversial and has not been validated
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