ST-segment Elevation: Myocardial Infarction or Simulacrum?

Area of Science:

• Cardiology
• Emergency Medicine
• Diagnostic Imaging

Background:

• ST-segment elevation myocardial infarction (STEMI) requires prompt diagnosis and treatment.
• A subset of patients with suspected STEMI present with conditions that mimic the electrocardiographic findings.
• These STEMI mimickers can lead to diagnostic delays and inappropriate management.

Purpose of the Study:

• To review and present rare but important clinical conditions that can mimic STEMI.
• To enhance clinician awareness of these alternative diagnoses.
• To improve the accuracy of STEMI diagnosis and patient outcomes.

Main Methods:

• Literature review of rare conditions presenting as STEMI.
• Case examples and discussion of diagnostic challenges.
• Emphasis on differential diagnosis in suspected STEMI.

Main Results:

• Identified several critical STEMI mimickers including coronary vasospasm, Takotsubo cardiomyopathy, Brugada syndrome, and aortic dissection.
• Highlighted the importance of considering non-coronary causes for ST-segment elevation.
• Demonstrated the potential for misdiagnosis without thorough evaluation.

Conclusions:

• Recognizing STEMI mimickers is essential for appropriate patient care.
• A broad differential diagnosis should be considered in STEMI alerts.
• Timely identification of these conditions prevents unnecessary interventions and guides correct treatment.