Causes of ST-Segment Elevation Other Than Acute Coronary Syndrome
| Cause | Clinical features |
|---|---|
| Acute pericarditis | Pain positional and worse on inspiration, pericardial rub, may not have coronary risk factors, may have viral prodrome (ECG see Table 7.4). Echocardiography shows no wall motion abnormality and may show pericardial fluid. |
| Stress cardiomyopathy (Takotsubo syndrome) | Usually follows emotional shock in a >65-year-old female (Table 45.5). Characteristic appearances on echocardiography, but angiography usually required to exclude coronary disease. |
| Early repolarization | A non-cardiac cause of pain associated with early repolarization can be confusing, but there will be no evolution of ECG changes (see Table 7.2) and no troponin release. |
| Aortic dissection | Dissection down the right coronary artery occurs in around 3% of acute type A dissections so this is rare. Consider if the chest pain is of immediate onset, radiates to the neck or back and is associated with neurological symptoms or signs. See Chapter 50. |
| Acute pancreatitis | Rare cause of ST segment changes. The history is atypical of a cardiac origin. See Chapter 79. |