STEMI mimics - Revision history

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2026-03-22T09:56:20Z

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← Revisión anterior		Revisión del 09:56 22 mar 2026
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	*While it is possible to have a STEMI from a ruptured plaque and subsequent clot formation in a patient with cocaine toxicity, it is helpful to risk stratify patients with a suspected STEMI by age, risk-factors, etc		*While it is possible to have a STEMI from a ruptured plaque and subsequent clot formation in a patient with cocaine toxicity, it is helpful to risk stratify patients with a suspected STEMI by age, risk-factors, etc
	*It may be impossible to tell by surface ECG (and therefore without a left heart catheterization) if the ST elevation is due to cocaine toxicity or due to plaque rupture		*It may be impossible to tell by surface ECG (and therefore without a left heart catheterization) if the ST elevation is due to cocaine toxicity or due to plaque rupture

			== Calculators ==
			{{Sgarbossa Calculator}}

	==See Also==		==See Also==

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2026-03-22T09:24:36Z

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	==Mnemonic==		==Mnemonic==
	The mnemonic “ELEVATION”, can help you remember STEMI mimics		The mnemonic “ELEVATION”, can help you remember STEMI mimics
	*~~'''E'''lectrolytes~~ ([[Hyperkalemia]])		*Electrolytes ([[Hyperkalemia]])
	*[[LBBB\|~~'''L'''eft~~ Bundle Branch Block]]		*[[LBBB\|Left Bundle Branch Block]]
	*[[early repolarization\|~~'''E'''arly~~ Repolarization]]		*[[early repolarization\|Early Repolarization]]
	*[[LVH\|~~'''V'''entricular~~ Hypertrophy]] (Left)		*[[LVH\|Ventricular Hypertrophy]] (Left)
	*[[LV aneurysm\|~~'''A'''neurysm~~ (Ventricular)]]		*[[LV aneurysm\|Aneurysm (Ventricular)]]
	*~~'''T'''hailand~~ ([[Brugada Syndrome]])		*Thailand ([[Brugada Syndrome]])
	*~~'''I'''nflammation~~ ([[Pericarditis]])		*Inflammation ([[Pericarditis]])
	*~~'''O'''sborne~~ (J) Waves ([[hypothermia]])		*Osborne (J) Waves ([[hypothermia]])
	*[[coronary artery vasospasm\|~~'''N'''on~~-Ischemic Vasospasm]]		*[[coronary artery vasospasm\|Non-Ischemic Vasospasm]]

	==ELEVATION==		==ELEVATION==

ClaireLewis: /* Mnemonic */

2019-09-26T16:49:30Z

Mnemonic

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	==Mnemonic==		==Mnemonic==
	The mnemonic “ELEVATION”, can help you remember STEMI mimics		The mnemonic “ELEVATION”, can help you remember STEMI mimics
	*'''E'''lectrolytes (Hyperkalemia)		*'''E'''lectrolytes ([[Hyperkalemia]])
	*'''L'''eft Bundle Branch Block		*[[LBBB\|'''L'''eft Bundle Branch Block]]
	*'''E'''arly Repolarization		*[[early repolarization\|'''E'''arly Repolarization]]
	*'''V'''entricular Hypertrophy (Left)		*[[LVH\|'''V'''entricular Hypertrophy]] (Left)
	*'''A'''neurysm (Ventricular)		*[[LV aneurysm\|'''A'''neurysm (Ventricular)]]
	*'''T'''hailand ([[Brugada Syndrome]])		*'''T'''hailand ([[Brugada Syndrome]])
	*'''I'''nflammation ([[Pericarditis]])		*'''I'''nflammation ([[Pericarditis]])
	*'''O'''sborne (J) Waves		*'''O'''sborne (J) Waves ([[hypothermia]])
	*'''N'''on-Ischemic Vasospasm		*[[coronary artery vasospasm\|'''N'''on-Ischemic Vasospasm]]

	==ELEVATION==		==ELEVATION==

Rossdonaldson1: /* Mnemonic */

2019-03-05T04:06:42Z

Mnemonic

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	*'''V'''entricular Hypertrophy (Left)		*'''V'''entricular Hypertrophy (Left)
	*'''A'''neurysm (Ventricular)		*'''A'''neurysm (Ventricular)
	*'''T'''hailand (Brugada Syndrome)		*'''T'''hailand ([[Brugada Syndrome]])
	*'''I'''nflammation (Pericarditis)		*'''I'''nflammation ([[Pericarditis]])
	*'''O'''sborne (J) Waves		*'''O'''sborne (J) Waves
	*'''N'''on-Ischemic Vasospasm		*'''N'''on-Ischemic Vasospasm

SLuckettG: /* Inflammation (Pericarditis) */

2019-03-01T14:31:01Z

Inflammation (Pericarditis)

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	===[[Pericarditis\|Inflammation (Pericarditis)]]===		===[[Pericarditis\|Inflammation (Pericarditis)]]===
	*~~Look for diffuse~~ ST elevation		*Diffuse ST elevation
	*~~PR depression is typically only seen in viral pericarditis, though the teaching is that this is a classic electrocardiographic sign of pericarditis~~		**In acute presentation, there may be PR elevation and ST depression in aVR only, but this is poorly sensitive
	*In acute ~~pericarditis~~, there ~~might~~ be PR elevation and ST depression in aVR only, but this is poorly sensitive		*PR depression classically taught as EKG sign of pericarditis but may only occur in viral pericarditis
	*Consider the diagnosis of STEMI in favor of pericarditis when: there is ST depression anywhere (except for V1, aVR), ST elevation height in III>II, there is a convex/horizontal ST elevation morphology, or when there are new Q waves		*Consider the diagnosis of STEMI in favor of pericarditis when: there is ST depression anywhere (except for V1, aVR), ST elevation height in III>II, there is a convex/horizontal ST elevation morphology, or when there are new Q waves
	*If predominantly inferior elevation, depression in aVL is very sensitive for STEMI<ref>Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med. 2016; 34(2):149-154.</ref>		*If predominantly inferior elevation, depression in aVL is very sensitive for STEMI<ref>Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med. 2016; 34(2):149-154.</ref>

SLuckettG: /* Thailand (Brugada Syndrome) */

2019-03-01T14:29:13Z

Thailand (Brugada Syndrome)

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	**Types 1 and 2 more commonly give ST elevation		**Types 1 and 2 more commonly give ST elevation
	**Type 3 has “saddle back” appearance without ST elevation		**Type 3 has “saddle back” appearance without ST elevation
	*~~Brugada pattern can~~ be pharmacologically unveiled (ex: antiarrhythmics such as sodium channel blockers), precipitated by illness or fever, or be intermittent (will commonly see an incomplete RBBB pattern)		*Can be pharmacologically unveiled (ex: antiarrhythmics such as sodium channel blockers), precipitated by illness or fever, or be intermittent (will commonly see an incomplete RBBB pattern)

	===[[Pericarditis\|Inflammation (Pericarditis)]]===		===[[Pericarditis\|Inflammation (Pericarditis)]]===

SLuckettG: /* Thailand (Brugada Syndrome) */

2019-03-01T14:28:42Z

Thailand (Brugada Syndrome)

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	===[[Brugada syndrome\|Thailand (Brugada Syndrome)]]===		===[[Brugada syndrome\|Thailand (Brugada Syndrome)]]===
	*~~Cause by a mutation in a cardiac~~ sodium channel (~~mostly~~ SCN5A)~~, was~~ first described in Thailand in 1992		*Cardiac sodium channel mutation (usually SCN5A) first described in Thailand in 1992
	*May be responsible for 4-5% of all sudden cardiac deaths		*May be responsible for 4-5% of all sudden cardiac deaths
	*3 described ECG types - Types 1 and 2 more commonly give ST elevation ~~while type~~ 3 has a “saddle back” appearance without ST elevation		*3 described ECG types:
	*Brugada pattern can be pharmacologically ~~induced~~ (ex: antiarrhythmics such as sodium channel blockers), precipitated by illness or fever, or be intermittent (will commonly see an incomplete RBBB pattern)		**Types 1 and 2 more commonly give ST elevation
			**Type 3 has “saddle back” appearance without ST elevation
			*Brugada pattern can be pharmacologically unveiled (ex: antiarrhythmics such as sodium channel blockers), precipitated by illness or fever, or be intermittent (will commonly see an incomplete RBBB pattern)

	===[[Pericarditis\|Inflammation (Pericarditis)]]===		===[[Pericarditis\|Inflammation (Pericarditis)]]===

SLuckettG: /* Aneurysm (Ventricular Aneurysm) */

2019-03-01T14:27:11Z

Aneurysm (Ventricular Aneurysm)

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	===[[Left ventricular aneurysm\|Aneurysm (Ventricular Aneurysm)]]===		===[[Left ventricular aneurysm\|Aneurysm (Ventricular Aneurysm)]]===
	*After an MI, ~~the~~ walls of ~~the~~ ventricles can become aneurysmal ~~and manifest on the surface 12 lead~~ as persistent ST elevation in ~~the~~ territory of ~~the~~ old infarct		*After MI, walls of ventricles can become aneurysmal
	*Q waves ~~(from the previous MI)~~ should be present in the leads with persistent ST elevation		**Manifests as persistent ST elevation in territory of old infarct
	*~~An echo~~ is required for the final confirmation		**Q waves should be present in the leads with persistent ST elevation
	*[[Takotsubo cardiomyopathy]] (broken heart syndrome) ~~will present~~ similarly.		*Echo is required for the final confirmation
			*[[Takotsubo cardiomyopathy]] (broken heart syndrome) presents similarly

	===[[Brugada syndrome\|Thailand (Brugada Syndrome)]]===		===[[Brugada syndrome\|Thailand (Brugada Syndrome)]]===

SLuckettG: /* Ventricular Hypertrophy (Left Ventricular Hypertrophy) */

2019-03-01T14:25:56Z

Ventricular Hypertrophy (Left Ventricular Hypertrophy)

← Revisión anterior		Revisión del 14:25 1 mar 2019
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	===[[Left ventricular hypertrophy (LVH)\|Ventricular Hypertrophy (Left Ventricular Hypertrophy)]]===		===[[Left ventricular hypertrophy (LVH)\|Ventricular Hypertrophy (Left Ventricular Hypertrophy)]]===
	*LVH typically with ‘strain’ pattern~~: in these cases, the~~ ST elevation should ~~only~~ be in V1-~~3, be concave-up (i.e. not a tombstone morphology), be discordant~~ with ~~the~~ deep S wave~~, and not be~~ elevated ~~>2mm~~		*LVH typically with ‘strain’ pattern
			*ST elevation should be:
			**In V1 - V3 only
			**Concave
			**Discordant with deep S wave
			**Not more than 2 mm elevated

	===[[Left ventricular aneurysm\|Aneurysm (Ventricular Aneurysm)]]===		===[[Left ventricular aneurysm\|Aneurysm (Ventricular Aneurysm)]]===

SLuckettG: /* Early Repolarization */

2019-03-01T14:24:42Z

Early Repolarization

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	*Synonymous with J-point elevation (though not to be confused with a J-wave) i.e. elevation of the point where the QRS usually meets the isoelectric line		*Synonymous with J-point elevation (though not to be confused with a J-wave) i.e. elevation of the point where the QRS usually meets the isoelectric line
	*Some studies suggest an increased risk of VF in these patients, though the lifetime risk remains unclear		*Some studies suggest an increased risk of VF in these patients, though the lifetime risk remains unclear
			*Elevation in this case should be concave and greatest in precordial leads

	===[[Left ventricular hypertrophy (LVH)\|Ventricular Hypertrophy (Left Ventricular Hypertrophy)]]===		===[[Left ventricular hypertrophy (LVH)\|Ventricular Hypertrophy (Left Ventricular Hypertrophy)]]===