How can ischemic changes be more readily recognized in myocardial infarction (MI, heart attack), and what are common nonischemic causes of ST-segment elevation?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Unfortunately, in a series of missed MI, failure to recognize ischemic changes was frequent. The inferior leads, in particular, must be scrutinized carefully for any evidence of ST-segment elevation by using a straight edge across the T-P segments of the electrocardiographic (ECG) tracing. Another common error is to recognize ischemic changes and then discharge the patient without definitively proving that the changes were preexistent. Nonischemic causes of ST-segment elevation include left ventricular hypertrophy, pericarditis, ventricular-paced rhythms, hypothermia, hyperkalemia, and left ventricular aneurysm. Nonischemic causes may lead to overtreatment.

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