PMID- 31885293
OWN - NLM
STAT- MEDLINE
DCOM- 20200629
LR  - 20200629
IS  - 1651-2006 (Electronic)
IS  - 1401-7431 (Linking)
VI  - 54
IP  - 2
DP  - 2020 Apr
TI  - Electrocardiographic changes in the differentiation of ischemic and non-ischemic 
      ST elevation.
PG  - 100-107
LID - 10.1080/14017431.2019.1705383 [doi]
AB  - 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.
FAU - Lindow, Thomas
AU  - Lindow T
AUID- ORCID: 0000-0002-2943-0034
AD  - Department of Clinical Physiology, Vaxjo Central Hospital, Vaxjo, Sweden.
AD  - Department of Research and Development, Region Kronoberg, Sweden.
AD  - Clinical Physiology, Skane University Hospital, Clinical Sciences, Lund 
      University, Lund, Sweden.
FAU - Pahlm, Olle
AU  - Pahlm O
AD  - Department of Research and Development, Region Kronoberg, Sweden.
FAU - Khoshnood, Ardavan
AU  - Khoshnood A
AUID- ORCID: 0000-0002-3142-4119
AD  - Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund 
      University, Lund, Sweden.
FAU - Nyman, Ingvar
AU  - Nyman I
AD  - Department of Clinical Physiology, Vaxjo Central Hospital, Vaxjo, Sweden.
FAU - Manna, Daniel
AU  - Manna D
AD  - Department of Clinical Physiology, Vaxjo Central Hospital, Vaxjo, Sweden.
FAU - Engblom, Henrik
AU  - Engblom H
AD  - Department of Research and Development, Region Kronoberg, Sweden.
FAU - Lassen, Annmarie Touborg
AU  - Lassen AT
AD  - Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
FAU - Ekelund, Ulf
AU  - Ekelund U
AD  - Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund 
      University, Lund, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20191230
PL  - England
TA  - Scand Cardiovasc J
JT  - Scandinavian cardiovascular journal : SCJ
JID - 9708377
SB  - IM
MH  - *Action Potentials
MH  - Adult
MH  - Aged
MH  - Arrhythmias, Cardiac/*diagnosis/physiopathology
MH  - Diagnosis, Differential
MH  - *Electrocardiography
MH  - Female
MH  - Heart Conduction System/*physiopathology
MH  - *Heart Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pericarditis/*diagnosis/physiopathology
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Takotsubo Cardiomyopathy/*diagnosis/physiopathology
MH  - Time Factors
MH  - Young Adult
OTO - NOTNLM
OT  - ECG
OT  - ST-elevation myocardial infarction
OT  - Takotsubo cardiomyopathy
OT  - early repolarization syndrome
OT  - perimyocarditis
EDAT- 2019/12/31 06:00
MHDA- 2020/07/01 06:00
CRDT- 2019/12/31 06:00
PHST- 2019/12/31 06:00 [pubmed]
PHST- 2020/07/01 06:00 [medline]
PHST- 2019/12/31 06:00 [entrez]
AID - 10.1080/14017431.2019.1705383 [doi]
PST - ppublish
SO  - Scand Cardiovasc J. 2020 Apr;54(2):100-107. doi: 10.1080/14017431.2019.1705383. 
      Epub 2019 Dec 30.