ACS/STEMI mimics – Acute Non-cardiac Pathology

Acute Non-cardiac pathology

Pulmonary embolism ST elevation lead III Sinus Tachycardia or AF
RBBB
Right heart strain pattern
S1Q3T3
Review major risks for PE
Raised ICP (any cause) Can be similar to STEMI or ischaemia
Widespread, deep T wave inversions (‘cerebral T waves’)
Predominantly neurological complaints and signs
Hypothermia Positive J point (negative in right-ward leads) in precordial leads [Osborn Waves] Various bradyarrhythmias Temperature < 32 degrees
Hypercalcaemia See Hypothermia QT shortening Severe hypercalcaemia
Sodium channel blocker toxicity See Bundle Branch Block Right axis deviation of the terminal QRS History of overdose
Hypokalaemia Widespread ST depression T wave flattening
U waves
Hyperkalaemia See Bundle Branch Block Widespread Peaked T waves
P / PR widening
K+ > 7mmol/K

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