ST elevation myocardial infarction differential diagnosis: Difference between revisions

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{{DiseaseDisorder infobox |
  DiseasesDB    = 16537 |
}}
{{ST elevation myocardial infarction}}
{{ST elevation myocardial infarction}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; {{AOEIC}} {{CZ}}


==Overview==
==Overview==
ST segment myocardial infarction can be broadly categorized, from a patient perspective, as chest pain. In addition, ST segment myocardial infarction diagnosis can be influence by both, the absence and presence of myonecrosis. A thorough differential diagnosis is necessary to eliminate extraneous causation within a patient diagnosis.
ST segment myocardial infarction can be broadly categorized, from a patient perspective, as chest pain. In addition, ST segment myocardial infarction diagnosis can be influence by both, the absence and presence of myonecrosis. A thorough differential diagnosis is necessary to eliminate extraneous causation within a patient diagnosis.


==Complete Differential Diagnosis of Chest Pain by Organ System==
==Complete Differential Diagnosis of Chest Pain==
====By Organ System====
{|style="width:60%; height:100px" border="1"
{|style="width:60%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[Herpes zoster]]•
|bgcolor="Beige"| [[Herpes zoster]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| Drugs to treat [[migraine headache]] •
|bgcolor="Beige"| Drugs to treat [[migraine headache]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| • [[Retropharyngeal abscess]] •
|bgcolor="Beige"| • [[Retropharyngeal abscess]]  
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 32: Line 36:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| • [[Achalasia]] • [[Abdominal distension]] • [[Barret’s esophagus]] • [[Carcinoma]] • [[Cholecystitis]] • [[Cholelithiasis]] • [[Diverticulitis]] • [[Duodenitis]] • [[Esophageal rupture]] • [[Esophageal spasm]] • [[Esophagitis]] • [[Foreign body]] • [[Gastritis]] • [[Gastroesophageal reflux]] ([[GERD]]) • [[Hiatus Hernia]] • [[Impacted stone]] • [[Liver abscess]] • [[Mallory-Weiss Syndrome]] • [[Neoplasm]] • [[nutcracker's esophagus|Nutcracker's esophagus]] • [[Pancreatitis]] • [[Peptic ulcer disease]] • [[Perforated ulcer]] • [[Plummer-Vinson Syndrome]] • [[Pneumoperitoneum]] • [[Splenomegaly|Splenic enlargement]] • [[Splenic infarction]] • Subdiaphragmatic abcsess • [[Subphrenic abscess]] • [[Whipple's Disease]] • 
|bgcolor="Beige"| • [[Achalasia]] • [[Abdominal distension]] • [[Barret’s esophagus]] • [[Carcinoma]] • [[Cholecystitis]] • [[Cholelithiasis]] • [[Diverticulitis]] • [[Duodenitis]] • [[Esophageal rupture]] • [[Esophageal spasm]] • [[Esophagitis]] • [[Foreign body]] • [[Gastritis]] • [[Gastroesophageal reflux]] ([[GERD]]) • [[Hiatus Hernia]] • [[Impacted stone]] • [[Liver abscess]] • [[Mallory-Weiss Syndrome]] • [[Neoplasm]] • [[nutcracker's esophagus|Nutcracker's esophagus]] • [[Pancreatitis]] • [[Peptic ulcer disease]] • [[Perforated ulcer]] • [[Plummer-Vinson Syndrome]] • [[Pneumoperitoneum]] • [[Splenomegaly|Splenic enlargement]] • [[Splenic infarction]] • Subdiaphragmatic abcsess • [[Subphrenic abscess]] • [[Whipple's Disease]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| • [[Bornholm disease]] • [[Hepatitis]] • [[HIV|HIV infection]] • [[Herpes Zoster]] • 
|bgcolor="Beige"| • [[Bornholm disease]] • [[Hepatitis]] • [[HIV|HIV infection]] • [[Herpes Zoster]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| • [[Tabes dorsalis]] •
|bgcolor="Beige"| • [[Tabes dorsalis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| • [[Liver cancer]] • [[Mesothelioma]] • [[Metastatic tumor]] • [[Neurofibroma]] • [[Pheochromocytoma]] •
|bgcolor="Beige"| • [[Liver cancer]] • [[Mesothelioma]] • [[Metastatic tumor]] • [[Neurofibroma]] • [[Pheochromocytoma]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| • [[Anxiety|Anxiety disorders]] • [[Affective disorders]] (e.g., [[depression]]) • [[Da costa's syndrome]] • Thought disorders (e.g., [[delusions|fixed delusions]]) • [[Hyperventilation syndrome]] • [[Hypochondria]] • [[Factitious disorders]] (e.g. [[Münchausen syndrome]] • [[Fabricated or induced illness]] • Hospital addiction syndrome) • [[Panic attack]] • [[Somatoform disorder]]s •  [[Somatization disorder]] •
|bgcolor="Beige"| • [[Anxiety|Anxiety disorders]] • [[Affective disorders]] (e.g., [[depression]]) • [[Da costa's syndrome]] • Thought disorders (e.g., [[delusions|fixed delusions]]) • [[Hyperventilation syndrome]] • [[Hypochondria]] • [[Factitious disorders]] (e.g. [[Münchausen syndrome]] • [[Fabricated or induced illness]] • Hospital addiction syndrome) • [[Panic attack]] • [[Somatoform disorder]]s •  [[Somatization disorder]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| • [[Asthma]] • [[Bronchial carcinoma]] • [[Bronchiectasis]] • [[Bronchogenic carcinoma]] • [[Carcinomatous]] • [[Pleural Effusion]] • [[Chronic Obstructive Pulmonary Disease]] ([[COPD]]) • [[Empyema]] • [[Hemothorax]] • [[Lung Abscess]] • [[Lung Cancer]] • [[Lymphoma]] • [[Mediastinitis]] • [[Pleuritis]] • [[Pleurodynia]] • [[Pneumomediastinum]] • [[Pneumonia]] • [[Pneumothorax]] • [[Pulmonary Embolism]] • [[Pulmonary Infarction]] • [[pneumothorax|Tension pneumothorax]] • [[Thymoma]] • Tracheoesophageal abscess • [[Tuberculosis]] • 
|bgcolor="Beige"| • [[Asthma]] • [[Bronchial carcinoma]] • [[Bronchiectasis]] • [[Bronchogenic carcinoma]] • [[Carcinomatous]] • [[Pleural Effusion]] • [[Chronic Obstructive Pulmonary Disease]] ([[COPD]]) • [[Empyema]] • [[Hemothorax]] • [[Lung Abscess]] • [[Lung Cancer]] • [[Lymphoma]] • [[Mediastinitis]] • [[Pleuritis]] • [[Pleurodynia]] • [[Pneumomediastinum]] • [[Pneumonia]] • [[Pneumothorax]] • [[Pulmonary Embolism]] • [[Pulmonary Infarction]] • [[pneumothorax|Tension pneumothorax]] • [[Thymoma]] • Tracheoesophageal abscess • [[Tuberculosis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes •
|bgcolor="Beige"| No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| • Collagen vascular disease with pleuritis • [[Conn's Syndrome]] • Degenerative changes of cervical spine • [[Familial Mediterranean Fever]] • [[Peritonitis]] • [[Pott's Disease]] • Xyphodenia •
|bgcolor="Beige"| • Collagen vascular disease with pleuritis • [[Conn's Syndrome]] • Degenerative changes of cervical spine • [[Familial Mediterranean Fever]] • [[Peritonitis]] • [[Pott's Disease]] • Xyphodenia  
|-
|-
|}
|}
====By Alphabetical Order====
*[[Actinomycosis]]
*[[Acute intermittent porphyria]]
*[[Adenosine]]
*[[Amonafide]]
*[[Anemia]]
*[[Ankylosing spondylitis]]
*[[Aortic valve stenosis]]
*[[Arsenic trioxide]]
*[[Arsenicals]]
*[[Blood transfusion]] and complications
*[[Bornholm disease]]
*[[Bronchogenic cyst]]
*[[Carbon monoxide toxicity]]
*[[Cardiomyopathy]]
*[[HOCM|Familial hypertrophic cardiomyopathy]]
*[[CPR|Cardiopulmonary resuscitation]]
*[[Coronary artery dissection]]
*[[Diffuse esophageal spasm]]
*[[Dissecting aortic aneurysm]]
*[[Dressler syndrome]]
*[[Empyema|Pleural empyema]]
*[[Esophageal achalasia]]
*[[Esophageal cyst]]
*[[Fabry disease]]
*[[Functional disorders]]
*[[Gastric ulcer]]
*[[Gastroesophageal reflux]]
*[[Gemeprost]]
*[[Glatiramer acetate]]
*[[Glycogenosis type 7]]
*[[Ischaemic heart disease]]
*[[Kawasaki disease]]
*[[Left ventricular hypertrophy]]
*[[Lymphangiomyomatosis]]
*[[Mediastinitis]]
*[[Mesothelioma]]
*[[Mitral valve prolapse]]
*[[Myocardial infarction]]
*[[Myocarditis]]
*[[Naratriptan]]
*[[Nylidrin]]
*[[Esophageal foreign body]]
*[[Esophageal rupture]]
*[[Esophagitis]]
*[[Pericarditis]]
*[[Pleural effusion]]
*[[Pleural fibroma]]
*[[Pleuritis]]
*[[Pneumonia]]
*[[Pneumothorax]]
*[[Porfimer]]
*[[Prinzmetal angina]]
*[[Pulmonary embolism]]
*[[Pulmonary infarction]]
*[[Quaternary syphilis]]
*[[Recurrent hereditary polyserositis]]
*[[Regadenoson]]
*[[Respiratory alkalosis]]
*[[Rib fracture]]
*[[Rib pain]]
*[[Rizatriptan]]
*[[Rumination disorder]]
*[[SAPHO syndrome]]
*[[Shingles]]
*[[Sickle cell crisis]] (thrombotic)
*[[Sickle cell disease]]
*[[Spinal cord injury|Acute spinal cord injury]]
*[[Subdiaphragmatic abscess]]
*[[Sumatriptan]]
*[[Syndrome X]]
*[[Tabes dorsalis]]
*[[Takotsubo cardiomyopathy]]
*[[Tension pneumothorax]]
*[[Thallium]]
*[[Thyroiditis]]
*[[Tietze costochondritis]]
*[[Trichinella spiralis]]
*[[Unstable angina]]
*[[Varicella-zoster virus]]
*[[Wegener granulomatosis]]
*[[Zolmitriptan]]


==Differential Diagnosis of Causes of ST Segment Elevation in the Absence of Myonecrosis==
==Differential Diagnosis of Causes of ST Segment Elevation in the Absence of Myonecrosis==
Acute epicardial artery occlusion by [[thrombus]] is certainly one cause of ST segment elevation, but other causes of ST segment elevation which are not associated with myonecrosis include the following: (listed in alphabetical order) <ref name="pmid14645641">{{cite journal |author=Wang K, Asinger RW, Marriott HJ |title=ST-segment elevation in conditions other than acute myocardial infarction |journal=N. Engl. J. Med. |volume=349 |issue=22 |pages=2128–35 |year=2003 |month=November |pmid=14645641 |doi=10.1056/NEJMra022580 |url=}}</ref><ref name="pmid15014192">{{cite journal |author=Ako J, Honda Y, Fitzgerald PJ |title=Conditions associated with ST-segment elevation |journal=N. Engl. J. Med. |volume=350 |issue=11 |pages=1152–5; author reply 1152–5 |year=2004 |month=March |pmid=15014192 |doi=10.1056/NEJM200403113501118 |url=}}</ref>
Acute epicardial artery occlusion by [[thrombus]] is certainly one cause of ST segment elevation, but other causes of ST segment elevation which are not associated with myonecrosis include the following:<ref name="pmid14645641">{{cite journal |author=Wang K, Asinger RW, Marriott HJ |title=ST-segment elevation in conditions other than acute myocardial infarction |journal=N. Engl. J. Med. |volume=349 |issue=22 |pages=2128–35 |year=2003 |month=November |pmid=14645641 |doi=10.1056/NEJMra022580 |url=}}</ref><ref name="pmid15014192">{{cite journal |author=Ako J, Honda Y, Fitzgerald PJ |title=Conditions associated with ST-segment elevation |journal=N. Engl. J. Med. |volume=350 |issue=11 |pages=1152–5; author reply 1152–5 |year=2004 |month=March |pmid=15014192 |doi=10.1056/NEJM200403113501118 |url=}}</ref>
 
====Listed in Alphabetical Order====


* [[Aneurysm]] of the ventricle can result in persistent ST segment elevation that can be exacerbated with tachycardia.
* [[Aneurysm]] of the ventricle can result in persistent ST segment elevation that can be exacerbated with tachycardia.
Line 142: Line 231:


While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might be differ substantially from that of plaque rupture: [[cocaine]] induced STEMI would not be treated with [[beta-blocker]]s, and [[myocardial contusion]] would not be treated with an [[antithrombin]]. These conditions include the following:
While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might be differ substantially from that of plaque rupture: [[cocaine]] induced STEMI would not be treated with [[beta-blocker]]s, and [[myocardial contusion]] would not be treated with an [[antithrombin]]. These conditions include the following:
====By Organ System====


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{{reflist|2}}
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{{STEMI}}
[[Category:Cardiology]]
 
[[Category:Pathology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Intensive care medicine]]


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Revision as of 14:21, 7 June 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

ST segment myocardial infarction can be broadly categorized, from a patient perspective, as chest pain. In addition, ST segment myocardial infarction diagnosis can be influence by both, the absence and presence of myonecrosis. A thorough differential diagnosis is necessary to eliminate extraneous causation within a patient diagnosis.

Complete Differential Diagnosis of Chest Pain

By Organ System

Cardiovascular • Acute Aortic Dissection • Acute Coronary Syndrome • (unstable angina) • (non ST elevation MI) • (ST elevation MI) • Aortic Aneurysm • Aortic Stenosis • Arryhthmias • Bland-White-Garland Syndrome • Chronic Stable Angina • Cor pulmonale • Coronary Heart Disease • Dressler's syndrome (postpericardiotomy) • Hypertrophic Cardiomyopathy • Mitral valve prolapse • Myocardial infarction • Myocarditis • Pericardial tamponade • Pericarditis • Takotsubos cardiomyopathy • Stress cardiomyopathy
Chemical / poisoning No underlying causes
Dermatologic Herpes zoster
Drug Side Effect Drugs to treat migraine headache
Ear Nose Throat • Retropharyngeal abscess
Endocrine • Acromegaly
Environmental No underlying causes
Gastroenterologic • Achalasia • Abdominal distension • Barret’s esophagus • Carcinoma • Cholecystitis • Cholelithiasis • Diverticulitis • Duodenitis • Esophageal rupture • Esophageal spasm • Esophagitis • Foreign body • Gastritis • Gastroesophageal reflux (GERD) • Hiatus Hernia • Impacted stone • Liver abscess • Mallory-Weiss Syndrome • Neoplasm • Nutcracker's esophagus • Pancreatitis • Peptic ulcer disease • Perforated ulcer • Plummer-Vinson Syndrome • Pneumoperitoneum • Splenic enlargement • Splenic infarction • Subdiaphragmatic abcsess • Subphrenic abscess • Whipple's Disease
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease • Bornholm disease • Hepatitis • HIV infection • Herpes Zoster
Musculoskeletal / Ortho • Bechterew's Disease • Bone tumor • Chest wall injuries • Chest wall pain syndrome • Costochondritis • Chosto condral tendinitis • Chosto sternal tendinitis • Tietze's syndrome • CS/TS osteochondrosis • Fibromyalgia • Fractured rib • Intercostal muscle spasm • Interstitial fibrosis • Intercostal neuralgia • Muscle strain or spasm • Myofascial pain • Myostitis • Neuritis • Radiculitis • Periostitis • Precordial catch syndrome • Shoulder bursitis • Shoulder tendinitis • Soft tissue sarcoma or tumor • Sternoclavicular arthritis • Strain of pectoralis muscle • Thoracic Outlet Syndrome • Trauma • Vertebrogenic thoracic pain
Neurologic • Tabes dorsalis
Nutritional / Metabolic No underlying causes
Oncologic • Liver cancer • Mesothelioma • Metastatic tumor • Neurofibroma • Pheochromocytoma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric • Anxiety disorders • Affective disorders (e.g., depression) • Da costa's syndrome • Thought disorders (e.g., fixed delusions) • Hyperventilation syndrome • Hypochondria • Factitious disorders (e.g. Münchausen syndrome • Fabricated or induced illness • Hospital addiction syndrome) • Panic attack • Somatoform disorders • Somatization disorder
Pulmonary • Asthma • Bronchial carcinoma • Bronchiectasis • Bronchogenic carcinoma • Carcinomatous • Pleural Effusion • Chronic Obstructive Pulmonary Disease (COPD) • Empyema • Hemothorax • Lung Abscess • Lung Cancer • Lymphoma • Mediastinitis • Pleuritis • Pleurodynia • Pneumomediastinum • Pneumonia • Pneumothorax • Pulmonary Embolism • Pulmonary Infarction • Tension pneumothorax • Thymoma • Tracheoesophageal abscess • Tuberculosis
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Trauma No underlying causes
Miscellaneous • Collagen vascular disease with pleuritis • Conn's Syndrome • Degenerative changes of cervical spine • Familial Mediterranean Fever • Peritonitis • Pott's Disease • Xyphodenia

By Alphabetical Order

Differential Diagnosis of Causes of ST Segment Elevation in the Absence of Myonecrosis

Acute epicardial artery occlusion by thrombus is certainly one cause of ST segment elevation, but other causes of ST segment elevation which are not associated with myonecrosis include the following:[1][2]

Listed in Alphabetical Order

  • Aneurysm of the ventricle can result in persistent ST segment elevation that can be exacerbated with tachycardia.
  • Balloon inflation in a coronary artery during percutaneous coronary intervention
  • Early repolarization is a normal variant that can result in ST segment elevation. It is more common in males of younger age. The ST elevation is exacerbated by bradycardia.
  • Hyperkalemia known as the "dialyzable current of njury" hyperkalemia may cause hyperacute ECG changes due to changes in membrane polarity
  • Left bundle branch block is associated with ST segment elevation in those leads that are discordant to the QRS. Stated differently, if the QRS is predominantly of a negative deflection, it is normal to observe ST segment elevation in the same leads. The presence of ST elevation in leads where the QRS deflection is upright (concordance) may be a marker of myocardial injury.
  • Myopericarditis can cause injury to the subepicardial myocytes and ST segment elevation.
  • Myocarditis can cause injury to the subepicardial myocytes and ST segment elevation.
  • Pericardiocentesis when the needle comes into contact with the myocardium, there can be ST segment elevation reflecting local injury of the myocardium.
  • Pericarditis can cause injury to the subepicardial myocytes and ST elevation.
  • Prinzmetal's angina is associated with ST segment elevation due to transient epicardial coronary artery spasm either in the absence or presence of atherosclerosis. If the condition persists long enough, myonecrosis can be observed.
  • Stroke Intracranial hemorrhage can in some cases cause ST segment elevation due to direct myocyte injury from a hyperadrenergic stimulation emanating from the central nervous system.

Differential Diagnosis of Causes of ST Segment Elevation in the Presence of Myonecrosis (STEMI)

While plaque rupture is the most common cause of ST segment elevation MI, other conditions can cause ST elevation and myocardial necrosis. In order to expeditiously treat an alternate underlying cause of myonecrosis, it is important to rapidly identify conditions other than plaque rupture that may also cause ST elevation and myonecrosis. Indeed, the management of some of these conditions might be differ substantially from that of plaque rupture: cocaine induced STEMI would not be treated with beta-blockers, and myocardial contusion would not be treated with an antithrombin. These conditions include the following:

By Organ System

Cardiovascular Aortic dissection more often extends to occlude the ostium of the right coronary artery

Aortic stenosis can cause subendocardial ischemia and infarction if demand grossly exceeds supply

Chemical / poisoning Carbon monoxide poisoning
Dermatologic No underlying causes
Drug Side Effect Oral contraceptive pills, particularly among women who smoke

Anabolic steroids

Ear Nose Throat A recent upper respiratory tract infections has been associated with a 4.9 fold rise in the risk of MI
Endocrine Thyrotoxicosis
Environmental Blizzards and snow shoveling, and inhalation of fine particulate matter in areas with air pollution and high traffic have been identified as triggers of MI.
Gastroenterologic A heavy meal has been associated with a 4 fold rise in the risk of MI, and it is not clear if this is mediated by hyperadrenergic tone[3];
Genetic Familial hypercholesterolemia
Hematologic Disseminated intravascular coagulation (DIC)

Hypercoagulable states

Polycythemia vera

Thrombocytosis

Iatrogenic Epinephrine overdose

Sudden withdrawal of Beta blockers or nitrates

Infectious Disease A recent upper respiratory tract infections has been associated with a 4.9 fold rise in the risk of MI

Infectious endocarditis may STEMI as a result of embolization

Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic A heavy meal has been associated with a 4 fold rise in the risk of MI and it is not clear if this is mediated by hyperadrenergic tone[3];

Amyloidosis

Fabry disease

Homocystinuria

Mucopolysaccharidoses or Hurler disease

Pseudoxanthoma elasticum

Thiamine deficiency has been associated with ST elevation and myonecrosis [4] [5] [6]

Obstetric/Gynecologic Spontaneous coronary dissection in the setting of pregnancy
Oncologic Radiation therapy can accelerate atherosclerosis particularly in the distribution of the left anterior descending artery;
Opthalmologic No underlying causes
Overdose / Toxicity Cocaine ingestion which may result in direct myocyte injury due to an adrendergic surge, vasoconstriction of the microvasculature or plaque rupture and thrombus formation;

Marijuana ingestion has been identified as a trigger of MI.

Psychiatric Anger, anxiety, bereavement, work-related stress, earthquakes, bombings and other psychosocial stressors have been identified as triggers of MI, and it is not clear if the mechanism is plaque rupture or hyperadrenergic tone;

Stress cardiomyopathy or Broken heart syndrome causes ST segment elevation most often in the anterior precordium and is thought to be due to direct myocyte injury from a hyperadrenergic stimulation emanating from the central nervous system.

Pulmonary A recent upper respiratory tract infections has been associated with a 4.9 fold rise in the risk of MI
Renal / Electrolyte Homocystinuria
Rheum / Immune / Allergy Takayasus
Sexual Sexual activity has been identified as a trigger of MI
Trauma Both penetrating and non-penetrating trauma to the heart or myocardial contusion, commotio cordis can be associated with ST elevation and myonecrosis.
Urologic No underlying causes
Miscellaneous Hypotension particularly if it is prolonged

References

  1. ↑ Wang K, Asinger RW, Marriott HJ (2003). "ST-segment elevation in conditions other than acute myocardial infarction". N. Engl. J. Med. 349 (22): 2128–35. doi:10.1056/NEJMra022580. PMID 14645641. Unknown parameter |month= ignored (help)
  2. ↑ Ako J, Honda Y, Fitzgerald PJ (2004). "Conditions associated with ST-segment elevation". N. Engl. J. Med. 350 (11): 1152–5, author reply 1152–5. doi:10.1056/NEJM200403113501118. PMID 15014192. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS (2004). "Heavy meals as a trigger for a first event of the acute coronary syndrome: a case-crossover study". Isr. Med. Assoc. J. 6 (12): 728–31. PMID 15609883. Unknown parameter |month= ignored (help)
  4. ↑ Kawano H, Koide Y, Toda G, Yano K (2005). "ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi". Intern. Med. 44 (6): 578–85. PMID 16020883. Unknown parameter |month= ignored (help)
  5. ↑ Hundley JM, Ashburn LL, Sebrell WH. The electrocardiogram in chronic thiamine deficiency in rats. Am J Physiol 144: 404–414, 1954.
  6. ↑ Read DH, Harrington DD (1981). "Experimentally induced thiamine deficiency in beagle dogs: clinical observations". Am. J. Vet. Res. 42 (6): 984–91. PMID 7197132. Unknown parameter |month= ignored (help)


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