ECG 6: STEMI mimics

Question 1

Criteria for benign early repolarization pattern

Answer 1

1. prominent notch or J wave at the end of QRS cocmplex or slur on the downstroke of the R wave
2. the peak of the notch or J wave is 0.1 mV or greater in amplitude in 2 or more contiguous leads, excluding V1 to V3 (to avoid cases of Brugada pattern)
   so look for these J wave or notch in the infeior or lateral leads
3. the QRS duration is normal

Question 2

remarks on benign early repolarization pattern

Answer 2

Its appearance is labile, being most prominent under conditions of increased vagal tone and decreasing with exercise

occurs in as many as 30% of the gen pop

and is most prevalent in young adults, esp athletes

Question 3

other names for Takotsubo cardiomyopathy

Answer 3

“transient left ventricular apical ballooning syndrome”

“stress cardiomyopathy”

Question 4

remarks on takotsubo cardiomyopathy

Answer 4

characterized by reversible wall motion abnormalities of the LV apex and midventricle

usually postmenopausal women

reported in the setting of *emotional or physiologic stress

may relate to coronary vasospasm or adrenergically mediatgegd myocardial damage

Question 5

remarks on CVA T wave pattern

Answer 5

seen in SAH
usually assoc’d with marked QT PROLONGATION
probably induced by excessive sympathetic stimulation mediated through the HYPOTHALAMUS
usually associated with BRADYCARDIA

Question 6

Examples of STEMI mimics

Answer 6

HABBLLOT
Hyperkalemia
Acute pericarditis
Benign early repolarization
Brugada syndrome
LVH strain
LBBB
Osborn waves (hypothermia, hypercalcemia)
Takotsubo CM