1/ #tweetorial
💠 Know the Differential for ST Segment Elevation: It’s More Than Just ACS
#meded #foame #medtwitter #cardiotwitter #cardioed
manualofmedicine.com/topics/cardiol…
💠 Know the Differential for ST Segment Elevation: It’s More Than Just ACS
#meded #foame #medtwitter #cardiotwitter #cardioed
manualofmedicine.com/topics/cardiol…
2/
➡️ Nonischemic causes of STE include:
👉Normal Variant STE
👉Early Repolarization
👉Brugada Syndr.
👉LVH
👉LBBB
👉Acute Pericarditis
👉Left Ventricular Aneurysm
👉Takotsubo Cardiomyopathy
👉Printzmetal Angina/Vasospasm
👉Pulmonary Embolism
👉Hyperkalemia
👉Post Cardioversion
➡️ Nonischemic causes of STE include:
👉Normal Variant STE
👉Early Repolarization
👉Brugada Syndr.
👉LVH
👉LBBB
👉Acute Pericarditis
👉Left Ventricular Aneurysm
👉Takotsubo Cardiomyopathy
👉Printzmetal Angina/Vasospasm
👉Pulmonary Embolism
👉Hyperkalemia
👉Post Cardioversion
3/
➡️Early Rep is a common cause of STE. Typically seen in younger males and in athletic.
➡️It's a risk factor for sudden cardiac death, as it increases the risk for idiopathic ventricular fibrillation.
➡️Typically produces a notched J-point with STE that is <3 mm on the ECG
➡️Early Rep is a common cause of STE. Typically seen in younger males and in athletic.
➡️It's a risk factor for sudden cardiac death, as it increases the risk for idiopathic ventricular fibrillation.
➡️Typically produces a notched J-point with STE that is <3 mm on the ECG
4/
➡️ECG features of Pericarditis:
👉Widespread saddle shaped (concave upward) STE
👉TWI only after the ST have returned to baseline
👉Q waves do not develop.
👉PR segment depression
👉ECG Changes occur over the course of several weeks, in contrast to rapid evolution in STEMI
➡️ECG features of Pericarditis:
👉Widespread saddle shaped (concave upward) STE
👉TWI only after the ST have returned to baseline
👉Q waves do not develop.
👉PR segment depression
👉ECG Changes occur over the course of several weeks, in contrast to rapid evolution in STEMI
5/
➡️ ECG features that favor STEMI over Pericarditis:
👉 Reciprocal ST-segment depression or T-wave inversions
👉 ST Elevation that is flat or horizontal should be considered an STEMI until proven otherwise.
👉 Rapid evolution of ST segment changes
➡️ ECG features that favor STEMI over Pericarditis:
👉 Reciprocal ST-segment depression or T-wave inversions
👉 ST Elevation that is flat or horizontal should be considered an STEMI until proven otherwise.
👉 Rapid evolution of ST segment changes
6/
➡️ In the setting of LBBB, the ST segment is directly opposite to that of the main QRS complex vector.
➡️ In leads V1 to V3, the QRS vector is negative, thereby producing ST Elevation.
➡️ In the setting of LBBB, the ST segment is directly opposite to that of the main QRS complex vector.
➡️ In leads V1 to V3, the QRS vector is negative, thereby producing ST Elevation.
7/
➡️ LVH produces discordant ST Elevation, with a deep S wave in leads V1 to V3 and a tall R wave in leads I, aVL, V5, and V6.
➡️ Left ventricular aneurysm may have STE along with deep anterior or septal Q waves in leads V1 to V3. Do not cause dynamic ECG abnormalities.
➡️ LVH produces discordant ST Elevation, with a deep S wave in leads V1 to V3 and a tall R wave in leads I, aVL, V5, and V6.
➡️ Left ventricular aneurysm may have STE along with deep anterior or septal Q waves in leads V1 to V3. Do not cause dynamic ECG abnormalities.
8/
➡️ Hyperkalemia is often referred to as the “great imitator” of ECG abnormalities. Can produce numerous ECG findings that can easily be misdiagnosed.
➡️ Hyperkalemia is often referred to as the “great imitator” of ECG abnormalities. Can produce numerous ECG findings that can easily be misdiagnosed.
9/
➡️ Prinzmetal Angina and Takotsubo Cardiomyopathy are often diagnosed as STEMI. These diagnoses are often made following emergent cardiac catheterization.
➡️ Prinzmetal Angina and Takotsubo Cardiomyopathy are often diagnosed as STEMI. These diagnoses are often made following emergent cardiac catheterization.
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