UMEM Educational Pearls

Category: Cardiology

Title: Mimics of STEMI

Keywords: ST-segment elevation (PubMed Search)

Posted: 5/17/2009 by Amal Mattu, MD (Updated: 12/6/2023)
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There are multiple causes of electrocardiographic ST-segment elevation which are well-known to mimic STEMI and often are a cause of misdiagnosis of STEMI.  These are:

  • Benign early repolarization
  • Pericarditis
  • Left ventricular aneurysm
  • Brugada syndrome
  • Left ventricular hypertrophy
  • Left bundle branch block
  • Paced rhythms
  • Hyperkalemia

Whenever there is doubt regarding whether you are dealing with a STEMI or a mimic, look for reciprocal ST-depression. Most of these will not produce ST-depression (LVH, LBBB, Pacers, and hyperkalemia WILL). The other key intervention is to perform serial ECGs and look for evolving changes, which strongly points to the presence of a true STEMI.