ST-segment elevation: Differential diagnosis, caveats

Hanna, Elias B.; Glancy, D. Luke

doi:10.3949/ccjm.82a.14026

Cited by 43 publications

(51 citation statements)

References 40 publications

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“…As a sign of myocardial ischemia, the change of ST segment elevation can reflect the degree of ischemic injury during coronary artery occlusion . The diagnosis of ST segment elevation includes different processes, such as ST segment elevation myocardial infarction and pericarditis . Some studies have demonstrated that exposure to PM air pollution was associated with ST segment elevation and can trigger acute coronary events, especially myocardial infarction associated with ST segment elevation (STEMI) .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular benefits of reducing personal exposure to traffic-related noise and particulate air pollution: A randomized crossover study in the Beijing subway system

et al. 2018

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To assess the cardiovascular benefits of protecting against particulate air pollution and noise, we conducted a randomized crossover study with 40 young healthy college students from March to May 2017 in the underground subway, Beijing. Participants each received 4 treatments (no intervention phase [NIP], respirator intervention phase [RIP], headphone intervention phase [HIP], respirator plus headphone intervention phase [RHIP]) in a randomized order during 4 different study periods with 2-week washout intervals. We measured personal exposure to particulate matter (PM), noise and electrocardiogram (ECG) parameters (heart rate variability (HRV), heart rate (HR) and ST segment changes), ambulatory blood pressure (BP) continuously for 4 hours to investigate the cardiovascular effects. Compared with NIP, most of the HRV parameters increased, especially high frequency (HF) [21.1% (95% CI: 15.7%, 26.9%), 18.2% (95% CI: 12.8%, 23.9%), and 35.5% (95% CI: 29.3%, 42.0%) in RIP, HIP, and RHIP, respectively], whereas ST segment elevation and HR decreased for all 3 modes of interventions. However, no significant differences were observed in BP among the 4 treatments. In summary, short-term wearing of a respirator and/or headphone may be an effective way to minimize cardiovascular risk induced by air pollution in the subway by improving autonomic nervous function.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular benefits of reducing personal exposure to traffic-related noise and particulate air pollution: A randomized crossover study in the Beijing subway system

et al. 2018

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“…The differential diagnosis for ST-elevation includes STEMI, aortic dissection, pulmonary embolism, stress (takotsubo) cardiomyopathy, pericarditis with or without effusion, myocarditis, hypercalcemia, hyperkalemia, coronary vasospasm, coronary artery dissection, left ventricular aneurysm, left ventricular hypertrophy, the Brugada syndrome, left bundle branch block, early repolarization, early post-cardioversion, intracranial hemorrhage, and rarely, tumor invasion of the heart 3,4,5,6 .…”

Section: Differential Diagnosismentioning

confidence: 99%

Squamous Cell Carcinoma Metastatic to the Heart Mimicking ST-Elevation Myocardial Infarction

Chen¹,

Craft²,

Panakos³

et al. 2016

TMF

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“…Despite being broadly available for more than a century, its composition remains unchanged, as does its place as a first line diagnostic exam in the approach of many cardiac diseases, being irreplaceable in the evaluation of thoracic pain syndromes. However, like in every diagnostic exam, the clinical context must never be dismissed, as many situations other than acute myocardial infarction (normal variant, pericarditis, hyperkalemia, and pulmonary embolism) may cause ST-segment elevation [1,2]. This clinical interpretation, being decisive for the immediate treatment of the ST-segment elevation myocardial infarction (STEMI), becomes of paramount importance in hospitals without conditions for primary angioplasty.…”

Section: Introductionmentioning

confidence: 99%

ST–Segment elevation: Not always an acute coronary syndrome

Costa

Meireles

Rodrigues

et al. 2017

ijcp

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Cardiac tumors can be primary or metastatic, the latter being more frequent and usually of pulmonary or hematologic origin. These patients' clinical signs are non-specific and the electrocardiogram (ECG) can assume many patterns, among which, ST-segment elevation. Nevertheless, associated occlusion of the coronary arteries is rare in these situations. We present a 79-year-old woman with a history of pulmonary neoplasia who was admitted to the emergency department due to prolonged atypical chest pain, cough and worsening dyspnea in the previous 3 days. The ECG revealed an ST-segment elevation in the lateral leads, despite normal blood work, with only residually elevated troponin I. Due to the disparity between the patient's symptoms and the ECG findings, a decision was made not to proceed to primary angioplasty, but to further investigate with echocardiography, which revealed a mass localized in the anterolateral and inferolateral left ventricle walls, confirmed by computed tomography. The patient was admitted in the medical ward for symptomatic management. Her clinical condition gradually deteriorated due to the disease's natural evolution and she died two weeks later. This case highlights the importance to keep in mind differential diagnoses to acute coronary syndromes, when a ST-segment elevation is encountered on a ECG.

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ST-segment elevation: Differential diagnosis, caveats

Cited by 43 publications

References 40 publications

Cardiovascular benefits of reducing personal exposure to traffic-related noise and particulate air pollution: A randomized crossover study in the Beijing subway system

Cardiovascular benefits of reducing personal exposure to traffic-related noise and particulate air pollution: A randomized crossover study in the Beijing subway system

Squamous Cell Carcinoma Metastatic to the Heart Mimicking ST-Elevation Myocardial Infarction

ST–Segment elevation: Not always an acute coronary syndrome

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