STEMI vs. Benign early repolarization vs. Pericarditis
Episode 35
May 7, 2012

Here’s some ugly ST-segment elevation but it’s NOT a straightforward diagnosis. Would you activate the cath lab at 1am for this? Or just sit on this one until the morning? Take 16 minutes to learn an approach to diagnosing the cause of ST elevation. 
 
Differential for Diffuse ST-Segment Elevation (STE)
  • Large STEMI
    • Sick patient, often with reciprocal changes
    • Morphologies are classically convex or horizontal, but can be concave as well​
    • STE in lead III>II, is highly indicative of STEMI
  • Pericarditis / Myocarditis
    • No reciprocal changes
    • Concave upwards STE
    • ​Diffuse PR-depression
    • STE Lead II>III
  • Early repolarization
    • ​No reciprocal changes
    • Concave upwards STE
    • STE in Lead II>III
    • Usually seen in young males
    • Similar appearance on old ECGs
  • Ventricular aneurysm
  • LBBB
  • LVH
  • Brugada syndrome
  • Hyperkalemia
Look for reciprocal changes to narrow your differential
 
STEMI vs. Benign early repolarization vs. Pericarditis
Episode 35
May 7, 2012

Here’s some ugly ST-segment elevation but it’s NOT a straightforward diagnosis. Would you activate the cath lab at 1am for this? Or just sit on this one until the morning? Take 16 minutes to learn an approach to diagnosing the cause of ST elevation. 
 
Differential for Diffuse ST-Segment Elevation (STE)
  • Large STEMI
    • Sick patient, often with reciprocal changes
    • Morphologies are classically convex or horizontal, but can be concave as well​
    • STE in lead III>II, is highly indicative of STEMI
  • Pericarditis / Myocarditis
    • No reciprocal changes
    • Concave upwards STE
    • ​Diffuse PR-depression
    • STE Lead II>III
  • Early repolarization
    • ​No reciprocal changes
    • Concave upwards STE
    • STE in Lead II>III
    • Usually seen in young males
    • Similar appearance on old ECGs
  • Ventricular aneurysm
  • LBBB
  • LVH
  • Brugada syndrome
  • Hyperkalemia
Look for reciprocal changes to narrow your differential

Watch this related episode for more…
 
  1. old-ekgumem posted this
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