Where along the ST segment do we measure? Where is the baseline? Figure 2: Demonstrating the baseline What is the J point? Figure 4: Demonstrating variability in measuring the J point Recognition of ST segment elevation without infarction i ST segment morphology i. Figure 5: ST segment morphology It has been reported that a non-concave i.
ST segment elevation is more diffuse in pericarditis see Table 2. Cardiac Causes. Table 4: Poor prognostic indicators associated with pericarditis The treatment for uncomplicated pericarditis is non-steroidal anti-inflammatory medication NSAIDs to relieve discomfort. Learning Bite Avoid steroids as first line treatment in idiopathic uncomplicated pericarditis Pitfall Discharging someone from ED without an echocardiogram means that not all poor prognostic indicators have been excluded and that an incomplete assessment has been made.
Table 5: Morphology of Brugada Syndrome types Figure 9: ECG characteristics of Brugada Syndrome: If Type 1 ECG morphology is demonstrated there is no need for drug testing but this is not the case in Types 2 and 3 where sodium channel blockers are used to confirm the diagnosis.
Learning Bite Consider Brugada Syndrome in anyone with downward sloping ST segment elevation in the right precordial chest leads Pitfall Be cautious of ruling out Brugada Syndrome in someone who gives you a good history just because they do not have the characteristic Type 1 ECG changes. Non-Cardiac Causes. Table 8: ECG features associated with PE 16 The presence of right ventricular dysfunction indicates a poorer prognosis and it has been suggested that these specific ECG findings can be used as an independent predictor of outcome MedicoLegal and other considerations.
Key Learning Points There are many causes of ST segment elevation which are unrelated to myocardial infarction. ST segment elevation is measured from the TP baseline to the J point. There are features on the ECG eg. BER is a normal finding in young males Level of evidence Grade 2b. Evaluation of ST segment criteria for the prehospital electrocardiographic diagnosis of myocardial infarction. Annals of Emergency Medicine ; 23 Academic Emergency Medicine ; 13; Mehta M , Jain AC.
Early Repolarization on scalar electrocardiogram. American Journal of Medical Sciences ; Universal definition of Myocardial Infarction. European Heart Journal ; 28; Emergency Medicine Journal ; 19; Brady WJ, et al.
Academic Emergency Medicine ; 8 Electrocardiographic findings in 67, asymptomatic subjects. Electrocardiogram with ST-segments elevated. Category Latest News. Want more? Like us! Latest News. Supraventricular tachycardia e. This rate-related ST depression does not necessarily indicate the presence of myocardial ischaemia, provided that it resolves with treatment. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation.
I do not believe that is correct. This site uses Akismet to reduce spam. Learn how your comment data is processed. EKG Library. Ed Burns. Robert Buttner.
One comment Hello! This is an excellent and concise article. Thank you! Leave a Reply Cancel reply. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Accepted 05 Sep Published 29 Nov Introduction Typical chest pain with elevated ST segment elevation on electrocardiogram EKG is a medical emergency, with well-drilled protocols and timeline targets [ 1 ]. Case Presentation A previously healthy year-old white male presented with sudden onset substernal chest pain that started while exercising on a treadmill one hour before.
Figure 1. Figure 2. Left coronary angiogram with normal left coronary anatomy with no obstructing atheroma. Figure 3. Right coronary angiogram with normal left coronary anatomy with no obstructing atheroma. Figure 4. Delayed postcontrast cardiac MRI 2-chamber view demonstrates midmyocardial enhancement in the inferior wall of the left ventricle adjacent to the apex. The subendocardial region is sparred right arrow. Mild pericardial delayed enhancement left arrow.
Figure 5. Corresponding T2 images of cardiac MRI 2-chamber view with an apical focal area of high T2 signal intensity in midmyocardium indicating focal edema at the apex.
Figure 6. Delayed postcontrast cardiac MRI short axis view demonstrating midmyocardial enhancement of the inferior wall of the left ventricle adjacent to the apex. Subendocardial sparring is again seen.
Figure 7. T1-weighted cardiac MRI short axis view demonstrating early enhancement ratios in the posterior epicardium and myocardium soon after gadolinium injection with sparing of the subendocardium blue arrow. References G. Levine, E. Bates, J. Blankenship et al. Nozari, M. Tajdini, M.
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