Is ST change always an MI? Top 18 Differentials of ST elevation you must know

18 Differential diagnoses of ST elevation

Table of Contents(toc)
18 Differential diagnoses of ST elevation

What is ECG?

ECG is a electrical graphical representation of cardiac electrical activity. It is plotted as voltage against time.

What is ST segment in an ECG?

ST segment normal and elevation

ST segment (as shown in image) is the segment between S and T wave in the ECG. Its electrically in baseline with 0 mV. 
Both ST segment elevation and depression can be sign of illness or underlying cardiac pathology. 

What are causes of ST Segment elevation?

ST segment normal elevation and depresion

Here is a comprehensive list of differential diagnosis of ST segment elevation in ECG / EKG.

1)MI
2) Pericarditis/Myocarditis
3) Cocaine abuse, 5FU, Triptans, Ergols
4) Repolarisation abn in Children
5) Brugada
6) ICH
7) Hypothermia
8) Hyperkalemia, -calcemia
9) Takutslubo CMP
10) LV aneurysm
11) LVH
12) LBBB
13) Prinzmetal Angina
14) Post DCCV
15) Anti arrythmii IC
16) Pulmonary embolism
17) Ventricule contusion/trauma
18) Ventricular tumor

Should I get an ECG done to check ST segment elevation?

Generally if you’re young, otherwise healthy individual you do not need to check for ST segment elevation or perform an ECG evaluation. 
But if you’re adult above 40, have systemic illness like hypertension (high BP), diabetes (sugar), thyroid disorder, pulmonary Illness like asthma, COPD, chronic cough, chest pain or anything similar your health care provider or doctor may order an ECG to check condition for your heart. 
You do not specifically order or request and ECG for ST segment evaluation. It’s part of your whole ECG as 12 lead ECG. 
Clinical classification of chest pain

What is an 12 lead ECG? 

12 lead ecg showing brugada syndrome

12 lead ECG is a type of ECG test most commonly done to check cardiac status. 
To perform 12 lead ecg, 10 different leads(wires) coming from an ECG machine are attached in your body i. Different locations viz. four in four lumbs, and six in anterior and left lateral side of chest (as shown in image).
From the four limb leads 3 are active leads(wires) which measure current directly while one is earthing wire. 

What is position of leads in 12 lead ECG?

Here is image showing position of leads in 12 lead ECG.
ecg lead placement position

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