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ST-segment elevation: are we cautious enough?

Published:January 21, 2013DOI:https://doi.org/10.1016/j.ajem.2012.12.017
      We read the case report of Sharma et al [
      • Sharma A.K.
      • Heist E.K.
      • Ferrell M.
      Treatment for ST-elevation myocardial infarction—bronchoscopy.
      ] with great interest and would like to share some more information. Although myocardial infarction has to be considered as the first and foremost with ST-segment elevation from an electrocardiogram for optimal management, however, there are various noncardiac fatal conditions present as ST-segment changes in electrocardiogram [
      • Wang K.
      • Asinger R.W.
      • Marriott H.J.
      ST-segment elevation in conditions other than acute myocardial infarction.
      ]. Furthermore, targets for reperfusion have drastically altered the assessment of patients with chest pain. Gu et al [
      • Gu Y.L.
      • Svilaas T.
      • van der Horst I.C.
      • Zijlstra F.
      Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention.
      ] reported an alternative diagnosis in 2.3% of patients with suspected ST-segment elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention, although it varies between 1.4% and 13% in literature [
      • Larson D.M.
      • Menssen K.M.
      • Johnson R.K.
      • Sharkey S.W.
      • Burke M.N.
      • Harris J.
      • et al.
      False positive ST elevation in patients undergoing direct percutaneous coronary intervention-Abstract 1756.
      ]. We have previously reported a case series of ST-segment abnormalities in spontaneous pneumothorax along with mechanisms for these changes [
      • Senthilkumaran S.
      • Meenakshisundaram R.
      • Michaels A.D.
      • Thirumalaikolundusubramanian P.
      Electrocardiographic changes in spontaneous pneumothorax.
      ].
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      References

        • Sharma A.K.
        • Heist E.K.
        • Ferrell M.
        Treatment for ST-elevation myocardial infarction—bronchoscopy.
        Am J Emerg Med. 2012; 30: 1660.e1-1660.e4
        • Wang K.
        • Asinger R.W.
        • Marriott H.J.
        ST-segment elevation in conditions other than acute myocardial infarction.
        N Engl J Med. 2003; 349: 2128-2135
        • Gu Y.L.
        • Svilaas T.
        • van der Horst I.C.
        • Zijlstra F.
        Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention.
        Neth Heart J. 2008; 16: 325-331
        • Larson D.M.
        • Menssen K.M.
        • Johnson R.K.
        • Sharkey S.W.
        • Burke M.N.
        • Harris J.
        • et al.
        False positive ST elevation in patients undergoing direct percutaneous coronary intervention-Abstract 1756.
        Circulation. 2006; 114: II_346
        • Senthilkumaran S.
        • Meenakshisundaram R.
        • Michaels A.D.
        • Thirumalaikolundusubramanian P.
        Electrocardiographic changes in spontaneous pneumothorax.
        Int J Cardiol. 2011; 153: 78-80
        • Sampson M.
        • Rose Jr., C.E.
        Reversible ST-segment elevation associated with atelectasis of the left lung.
        South Med J. 2005; 98: 950-952
        • Zou M.H.
        • Bachschmid M.
        Hypoxia-reoxygenation triggers coronary vasospasm in isolated bovine coronary arteries via tyrosine nitration of prostacyclin synthase.
        J Exp Med. 1999; 190: 135-139