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.
(Less)
- author
- Lindow, Thomas
LU
; Pahlm, Olle
LU
; Khoshnood, Ardavan
LU
; Nyman, Ingvar
; Manna, Daniel
; Engblom, Henrik
LU
; Lassen, Annmarie Touborg
and Ekelund, Ulf
LU
- organization
- publishing date
- 2020-04-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Electrocardiogram, ECG, Ischemia, Chest pain, Elektrokardiogram, EKG, Ischemi, Bröstsmärta
- in
- Scandinavian cardiovascular journal : SCJ
- volume
- 54
- issue
- 2
- pages
- 8 pages
- publisher
- Taylor & Francis
- external identifiers
-
- pmid:31885293
- scopus:85077889583
- ISSN
- 1651-2006
- DOI
- 10.1080/14017431.2019.1705383
- project
- AIR Lund - Artificially Intelligent use of Registers
- language
- English
- LU publication?
- yes
- id
- a5ec035d-1463-4329-a774-b34bc08d857e
- date added to LUP
- 2020-01-06 07:16:41
- date last changed
- 2023-11-19 21:14:09
@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 < .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}},
keywords = {{Electrocardiogram; ECG; Ischemia; Chest pain; Elektrokardiogram; EKG; Ischemi; Bröstsmärta}},
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}},
}