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Prof Naveen Garg, Lucknow 04 January 2018

Clinical setting and awareness of the conditions that mimic infarction can help differentiate the conditions.
The shape of the ST-segment elevation, the leads involved, other features of the ECG are very helpful. In cases with slightest of doubt, coronary angiography should be done in early presenters.
Once cardiac etiology is ruled out, other diagnosis should be sought.
Clinical possibilities in a patient presenting with chest pain with transient ST elevation with normal coronaries or minor plaquing: Myocardial infarction with recanalyzed vessel; nonatherosclerotic CAD (hypercoagulable states, coronary embolism, arteritis, coronary artery anomalies, myocardial bridge, substance abuse); coronary vasospasm (Prinzmetal’s angina); Takotsubo cardiomyopathy; noncardiac chest pain with transient ST elevation due to some other cause than AMI.
Causes of ST elevation other than AMI: Normal variants; early repolarization; LBBB; LVH; WPW syndrome; hyperkalemia; pulmonary embolism; acute pericarditis; acute myocarditis; Brugada syndrome; abdominal causes; neurogenic: SAH and head injury.

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