Atrial Repolarization as a Rare Mimicker of ST-Segment Elevation Myocardial Infarction: Revisiting Ta
Jian Chu1, Roopesh Sai Jakulla1, Krittapoom Akrawinthawong1
1Division of Cardiac Electrophysiology, Department of Cardiovascular Medicine, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA.
Insights
Low atrial ectopic rhythms can mimic ST-segment elevation myocardial infarction (STEMI) on electrocardiograms (ECGs). This case highlights how atrial repolarization can cause ST elevations, emphasizing the need for careful ECG interpretation to avoid misdiagnosis of STEMI.
Area of Science:
- Cardiology
- Electrocardiography
- Cardiac Electrophysiology
Background:
- ST-segment elevations on ECG are crucial for diagnosing myocardial infarction.
- Rare ECG findings can mimic ST-segment elevation myocardial infarction (STEMI), leading to unnecessary interventions.
- Complex congenital heart disease can present diagnostic challenges in critical care settings.
Background:
The identification of ST-segment elevations on a 12-lead electrocardiogram (ECG) is critical to the prompt management of myocardial infarction, but rare mimickers can lead to unwarranted cascade testing.
Case Summary:
A 25-year-old woman was admitted with severe hypoxia and was found to have uncorrected complex congenital heart disease. She underwent right heart catheterization and developed abdominal pain postprocedurally. A 12-lead ECG demonstrated inferior and lateral lead Q waves and ST-segment elevations.
Discussion:
Given recent cardiac catheterization and presence of a large right-to-left intracardiac shunt, there was a concern for ST-segment elevation myocardial infarction (STEMI) from coronary artery embolism. An ECG was promptly repeated and showed normalization of ST segments. Her index ECG was felt to represent a low atrial ectopic rhythm with ST-segment elevations secondary to atrial repolarization.
Take-Home Message:
Atrial repolarization is often indiscernible on the standard 12-lead ECG but can be evident in low atrial ectopic rhythms as ST-segment elevations, leading to misdiagnosis of STEMI.
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