STEMI mimics

Question 1

What can mimic STEMI

Answer 1

-raised intercranial pressure
-LBBB
-paced rhythms
-electrolyte disturbances
-Bragada syndrome
-PE
-L V hypertrophy
-hypothermia

Question 2

Benign early repolarisation pathophysiology

Answer 2

-imbalance in ion channel system
-causes variable refractoriness of multiple myocardial regions leading to variable excitability of myocardium
-if early repolarisation pattern is seen in inferior or lateral leads, high indication for sudden cardiac death

Question 3

When to suspect benign early repolarisation

Answer 3

-more common in younger patients
-BER should not be suspected in patients over 50

Question 4

ECG features of BER

Answer 4

-widespread concave ST elevation, most prominent in V2-V5
-slurring at J point
-asymmetrical T waves that are concordant with QRS
-no reciprocal ST depression to indicate STEMI

Question 5

What is pericarditis

Answer 5

-inflammation of pericardium usually due to infection
-pericarditis not usually serious compared to ACS

Question 6

ECG features of pericarditis

Answer 6

-widespread concave ST elevation
-PR depression in limb leads and V2-V6
-reciprocal ST depression and PR elevation in aVR
-sinus tachycardia

Question 7

Spodick’s sign

Answer 7

-downward sloping T-P segment on ECG
-early manifestation of pericarditis

Question 8

How to differentiate BER from pericarditis

Answer 8

-BER ST elevation only in chest leads, pericarditis is generalised
-BER has no PR depression but pericarditis does
-T wave is prominent in BER and normal in pericarditis
-ST segment: T wave ratio is less than 0.25 in BER and greater than 0.25 in pericarditis in V6