STEMI mimics ST elevations on ECG: alternative diagnoses to acute coronary occlusion

Background The electrocardiogram (ECG) is an integral part of basic emergency medical diagnosis and preoperative evaluation. In cases of ST elevation myocardial infarction (STEMI) immediate treatment is mandatory after correlation of ischemic symptoms with the ECG pattern. However, there are also ECG patterns that can imitate STEMI, possibly resulting in the true underlying diagnosis being missed and inappropriate therapy being initiated. Objectives This paper provides an overview of the most important diagnoses that can imitate STEMI on ECG. Material and methods A literature search was carried out to determine the most important differential diagnoses of ST elevation on ECG. These STEMI mimics are discussed in detail and their relevance for emergency medicine is explained. Results This article provides an overview of differential diagnoses that should be known in emergency medicine when assessing an ECG with ST elevations. Conclusion Good knowledge of the ECG patterns presented here can support decision-making in emergency medicine.