STEMI mimics

Question 2

What conditions can mimic STEMIs?

Answer 2

• Raised ICP
• LBBB/Paced Rhythms
• Electrolyte Disturbance
• Bragada Syndrome
• PE
• Left Ventricular Hypertrophy
• Hypothermia

These conditions can present with similar ECG changes to STEMI.

Question 3

What is Benign Early Repolarisation (BER)?

Answer 3

A phenomenon suspected to be due to an imbalance in the ion channel system, leading to variable refactoriness of myocardial regions and specific ECG findings

While termed ‘benign’, BER indicates no myocardial ischaemia/infarction.

Question 4

Which demographic is more commonly affected by Benign Early Repolarisation (BER)?

Answer 4

Younger people

Less common in individuals over 50 years old.

Question 5

What are the ECG features of Benign Early Repolarisation (BER)?

Answer 5

• Widespread concave ST elevation, prominent in V2-5
• Notching or slurring at the J point
• Prominent, slightly asymmetrical T waves concordant with the QRS complex
• No reciprocal ST depression

These findings can mimic STEMI.

Question 6

What must be ruled out in patients over 50 years old before diagnosing BER?

Answer 6

Acute Coronary Syndrome (ACS)

ST elevation in this age group is more likely to indicate ACS.

Question 7

What is Pericarditis?

Answer 7

Inflammation of the Pericardium, usually due to infection

It has similarities and differences compared to ACS.

Question 8

What are the ECG features of Pericarditis?

Answer 8

• Widespread concave ST elevation and PR depression in limb and precordial leads
• Reciprocal ST depression and PR elevation in lead aVR (± V1)
• Sinus tachycardia common due to pain or pericardial effusion

These features help differentiate it from ACS.

Question 9

What is Spodick’s Sign?

Answer 9

Downwards sloping T-P segment seen as an early ECG manifestation in Pericarditis

This sign can aid in the diagnosis of Pericarditis.

Question 10

How does BER differ from Pericarditis in terms of ST elevation and PR depression?

Answer 10

BER: * ST elevation limited to precordial leads
* No PR depression
* ST segment / T wave ratio < 0.25
* ‘Fish hook’ appearance in V4

Pericarditis: * ST elevation in all/any leads
* PR depression present
* ST segment / T wave ratio > 0.25

These differences are crucial for differential diagnosis.

Question 11

What is the significance of the ST segment / T wave ratio in ECG interpretation?

Answer 11

A ratio > 0.25 suggests pericarditis, while a ratio < 0.25 suggests BER

The ratio is determined by comparing the height of ST elevation to T wave amplitude in V6.