- ST-segment elevation in lead aVR portends a worse prognosis in ACS and often predicts the need for CABG.
- Hyperacute T-waves are not necessarily tall, and small T-waves can still be hyperacute when paired with a low-amplitude QRS complex.
- The tall T-waves associated with hyperkalemia are sharp, pointy, symmetric, and have a narrow base.
- When in doubt, get serial ECGs (every 15 minutes) and use adjunctive information.
Causes of Elevated Troponin
|Noncardiac Causes||Cardiac Causes|
|Acute Noncardiac Critical Illness||Acute and Chronic Heart Failure|
|Acute Pulmonary Edema||Acute Inflammatory Myocarditis or Endocarditis/Pericarditis|
|Acute Pulmonary Embolism||Aortic Dissection|
|Cardiotoxic Drugs||Aortic Valve Disease|
|Stroke, Subarachnoid hemorrhage||Apical Ballooning Syndrome|
|Chronic Obstructive Pulmonary Disease||Bradyarrhythmia, Heart Block|
|Chronic renal failure||Cardiac contusion from trauma|
|Extensive Burns||Cardiac surgery, Post-percutaneous Coronary Intervention, Endomyocardial biopsy|
|Infiltrative Disease (Amyloidosis)||Cardioversion|
|Rhabdomyolysis with Myocyte Necrosis||Direct Myocardial Trauma|
|Sever Pulmonary Hypertension||Tachycardia/Tachyarrhythmia, Bradyarrhythmia|
|Strenuous Exercise/Extreme Exertion|
Criteria for diagnosis of posterior STEMI include:
- ST-depression ≥0.5mm in leads V1-V3.
- Associated T-waves are either upright or inverted.
- Appearance of tall R-waves in V1-V2 (may be delayed).
- Recommended: posterior chest wall leads (V7-V9 ≥0.5 mm* ST-elevation).
*may be decreased secondary to increased distance of posterior leads from heart.