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Cause of ST segment abnormality in ED chest pain patients
W J Brady1, A D Perron, M L Martin
1Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
ST segment elevation (STE) on ECGs in chest pain patients is often not caused by acute myocardial infarction (AMI). Left ventricular hypertrophy (LVH) and left bundle branch block (LBBB) are more frequent causes of STE than AMI.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- ST segment elevation (STE) on a 12-lead electrocardiogram (ECG) is a critical finding in chest pain patients.
- Distinguishing acute myocardial infarction (AMI) from other causes of STE is essential for timely and appropriate treatment.
Purpose of the Study:
- To determine the electrocardiographic diagnoses of chest pain patients presenting with ST segment elevation (STE).
- To identify the most common causes of STE in an emergency department (ED) setting.
Main Methods:
- Retrospective review of 12-lead ECGs from adult chest pain patients in a university hospital ED.
- Analysis of 902 patients meeting entry criteria over a 3-month period.
- Defined STE as >/=1 mm in limb leads and >/=2 mm in precordial leads in at least two contiguous leads.
Main Results:
- 202 out of 902 patients (22.4%) exhibited STE.
- Acute myocardial infarction (AMI) was the final diagnosis in only 31 (15%) of STE cases.
- Non-AMI causes of STE included left ventricular hypertrophy (LVH) (25%), left bundle branch block (LBBB) (15%), and benign early repolarization (BER) (12%).
Conclusions:
- Acute myocardial infarction (AMI) is not the most common cause of ST segment elevation (STE) in emergency department chest pain patients.
- Left ventricular hypertrophy (LVH) is the most frequent cause of electrocardiographic STE, followed by AMI and LBBB at equal frequencies.
Abstract:
The objective of this study was to determine the electrocardiographic diagnoses of chest pain patients with ST segment elevation (STE) on the 12-lead electrocardiogram (ECG). This study was a retrospective ECG review of adult chest pain patients in a university hospital emergency department (ED) over a 3-month period (January 1, 1996 to March 31, 1996). STE was determined if the ST segment was elevated >/=1 mm in the limb leads and >/=2 mm in the precordial leads in at least two anatomically contiguous leads. Results showed 902 patients who met entry criteria and of whom 202 (22.4%) had STE. Thirty-one (15%) patients had STE acute myocardial infarction (AMI) as the final hospital diagnosis which caused the STE; 171 (85%) patients with STE had non-AMI diagnosis responsible for the ST segment elevation, including left ventricular hypertrophy (LVH) 51 (25%), left bundle branch block (LBBB) 31 (15%), benign early repolarization (BER) 25 (12%), right bundle branch block 10 (5%), nonspecific bundle branch block 10 (5%), left ventricular aneurysm 5 (3%), acute pericarditis 2 (1%), ventricular paced rhythm 2 (1%), and undefined ST segment elevation 35 (17%). Forty-four patients had AMI as the final diagnosis of whom 31 showed STE on presentation to the ED. In 2 of 31 (6%) cases of STE AMI, the ST segment waveform was atypical for acute infarction. We concluded that AMI is not the most common cause of STE in ED chest pain patients. LVH is most often responsible for electrocardiographic STE followed by AMI and LBBB which occur at equal frequencies.