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Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation

Lindow, Thomas LU ; Pahlm, Olle LU ; Khoshnood, Ardavan LU ; Nyman, Ingvar ; Manna, Daniel ; Engblom, Henrik LU ; Lassen, Annmarie Touborg and Ekelund, Ulf LU (2020) In Scandinavian cardiovascular journal : SCJ 54(2). p.100-107
Abstract

Objectives: Pericarditis, takotsubo cardiomyopathy and early repolarization syndrome (ERS) are well-known to mimic ST elevation myocardial infarction (STEMI). We aimed to study whether ECG findings of reciprocal ST depression, PR depression, ST-segment convexity or terminal QRS distortion can discriminate between ST elevation due to ischemia and non-ischemic conditions. 

Design: Eighty-five patients with STEMI and 94 patients with non-ischemic ST elevation were included. All patients had acute chest pain and at least 0.1 mV ST elevation. Presence of PR depression, ST-segment convexity, terminal QRS distortion or reciprocal ST depression was assessed in each ECG. 

Results: In anterior ST elevation, ST depression in lead II... (More)

Objectives: Pericarditis, takotsubo cardiomyopathy and early repolarization syndrome (ERS) are well-known to mimic ST elevation myocardial infarction (STEMI). We aimed to study whether ECG findings of reciprocal ST depression, PR depression, ST-segment convexity or terminal QRS distortion can discriminate between ST elevation due to ischemia and non-ischemic conditions. 

Design: Eighty-five patients with STEMI and 94 patients with non-ischemic ST elevation were included. All patients had acute chest pain and at least 0.1 mV ST elevation. Presence of PR depression, ST-segment convexity, terminal QRS distortion or reciprocal ST depression was assessed in each ECG. 

Results: In anterior ST elevation, ST depression in lead II (≥0.025 mV) occurred in 40% of patients with STEMI but in none of the non-ischemic cases. In inferior ST elevation, ST depression in lead I (≥0.025 mV) was present in 83% of patients with STEMI but in none of the non-ischemic cases. Chest-lead PR depression was uncommon in STEMI (12%) compared to non-ischemic cases (38%; p < .001). Convex ST elevation occurred in 22% of STEMI cases and in 9% of non-ischemic cases (p = .01). Terminal QRS distortion was more prevalent in STEMI (40%) than in non-ischemic ST elevation (7%). In multivariable analysis, reciprocal ST depression was associated with an ischemic diagnosis, whereas ST depression in aVR and chest-lead PR depression were associated with a non-ischemic diagnosis. 

Conclusions: Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.

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Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Electrocardiogram, ECG, Ischemia, Chest pain, Elektrokardiogram, EKG, Ischemi
in
Scandinavian cardiovascular journal : SCJ
volume
54
issue
2
pages
8 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85077889583
  • pmid:31885293
ISSN
1651-2006
DOI
10.1080/14017431.2019.1705383
language
English
LU publication?
yes
id
a5ec035d-1463-4329-a774-b34bc08d857e
date added to LUP
2020-01-06 07:16:41
date last changed
2020-07-08 05:10:16
@article{a5ec035d-1463-4329-a774-b34bc08d857e,
  abstract     = {<p>Objectives: Pericarditis, takotsubo cardiomyopathy and early repolarization syndrome (ERS) are well-known to mimic ST elevation myocardial infarction (STEMI). We aimed to study whether ECG findings of reciprocal ST depression, PR depression, ST-segment convexity or terminal QRS distortion can discriminate between ST elevation due to ischemia and non-ischemic conditions. </p><p>Design: Eighty-five patients with STEMI and 94 patients with non-ischemic ST elevation were included. All patients had acute chest pain and at least 0.1 mV ST elevation. Presence of PR depression, ST-segment convexity, terminal QRS distortion or reciprocal ST depression was assessed in each ECG. </p><p>Results: In anterior ST elevation, ST depression in lead II (≥0.025 mV) occurred in 40% of patients with STEMI but in none of the non-ischemic cases. In inferior ST elevation, ST depression in lead I (≥0.025 mV) was present in 83% of patients with STEMI but in none of the non-ischemic cases. Chest-lead PR depression was uncommon in STEMI (12%) compared to non-ischemic cases (38%; p &lt; .001). Convex ST elevation occurred in 22% of STEMI cases and in 9% of non-ischemic cases (p = .01). Terminal QRS distortion was more prevalent in STEMI (40%) than in non-ischemic ST elevation (7%). In multivariable analysis, reciprocal ST depression was associated with an ischemic diagnosis, whereas ST depression in aVR and chest-lead PR depression were associated with a non-ischemic diagnosis. </p><p>Conclusions: Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.</p>},
  author       = {Lindow, Thomas and Pahlm, Olle and Khoshnood, Ardavan and Nyman, Ingvar and Manna, Daniel and Engblom, Henrik and Lassen, Annmarie Touborg and Ekelund, Ulf},
  issn         = {1651-2006},
  language     = {eng},
  month        = {04},
  number       = {2},
  pages        = {100--107},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian cardiovascular journal : SCJ},
  title        = {Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation},
  url          = {http://dx.doi.org/10.1080/14017431.2019.1705383},
  doi          = {10.1080/14017431.2019.1705383},
  volume       = {54},
  year         = {2020},
}