A wrong diagnosis led patients to unnecessary (invasive or conservative) cares. Furthermore, the problem of equivocal electrocardiographic features is frequent in the departments of emergency care, especially in patients with hypertension or previous history of MI. Despite the high sensitivity, the ST segment deviation has, however, a poor specificity since it may be observed in many other conditions (such as left bundle branch block, hypertrophic cardiomyopathy or left ventricle aneurysm). In an ECG recorded at a paper speed of 25 mm/s and an amplification of 10 mm/mV, the ST segment elevation from the baseline should be measured 80 ms after the J point and is considered present if the deviation is ≥0.2 mV in men and ≥0.15 mV in women in V2–V3 leads (≥0.1 mV in other leads). It is possible to make diagnosis of acute ST segment Elevation Myocardial Infarction (STEMI) when, in a certain clinical context, a new ST segment elevation is detected in at least two continuous leads. The earliest manifestations of myocardial ischemia typically interest T waves and ST segment. It is the easiest and available instrument to confirm or exclude the diagnosis of MI and to decide the appropriate treatment strategy. The twelve-lead electrocardiogram (ECG) is then an integral part of the diagnostic work up of patient with acute chest discomfort. Indeed, the typical clinical presentation may be absent and a non-specific elevation of plasmatic levels of cardiac troponin I could be detectable. In many cases, the accurate diagnosis of myocardial infarction (MI) may be, however, a real challenge. In this setting, some aspects such as clinical features and biomarkers of myocardial necrosis may have an important role. The aim of our review is to overview of the main conditions that may mimic a ST segment Elevation Myocardial Infarction (STEMI).Įmergency physicians, frequently, deal with patients symptomatic for acute chest pain. Therefore, when ST–T abnormalities are detected the physicians should take into account many other parameters (such as risk factors, symptoms and anamnesis) and all the other differential diagnoses. Despite the high sensitivity, ST segment deviation has however poor specificity since it may be observed in many other cardiac and non-cardiac conditions. However, the interpretation of electrocardiograms of these patients may be a real concern. Various tools such as anamnesis, blood sample (with evaluation of markers of myocardial necrosis), ultrasound techniques and coronary computed tomography could be useful. The diagnosis of acute myocardial infarction may be a challenge. Chest pain is one of the chief presenting complaints among patients attending Emergency department.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |