ST elevation: Differential diagnosis and caveats. A comprehensive review to help distinguish ST elevation myocardial infarction from nonischemic etiologies of ST elevation

Erwin Christian de Bliek

Jessa Hospital/Heart Centre Hasselt, Hasselt, Belgium

Keywords: Electrocardiography ,Repolarization abnormalities ,ST segment elevation ,Myocardial infarction ,Pericarditis
,Myocarditis
,Takotsubo cardiomyopathy
,J wave,
Early repolarization
,Brugada syndrome,
Left bundle branch block ,Hypertrophy
,Ventricular pacing ,Hyperkalemia ,Hypercalcemia

Abstract

Prompt diagnosis of acute ST segment elevation myocardial infarction (STEMI) by the initial ECG is important in order to perform an urgent coronary angiography as soon as possible and achieve successful revascularization, therewith improving mortality and morbidity. Several diseases and conditions can mimic an acute myocardial infarction (AMI) but may not benefit from a (percutaneous) revascularization strategy. This narrative clinical review will discuss the ECG features of some of the causes of non-ischemic ST segment elevation to facilitate early recognition, prevent wrongful diagnosis and improve treatment outcomes.