Differential Diagnosis for 3 mm ST Segment Elevations in Leads V1 to V4
- The following differential diagnosis is organized into categories to guide the thought process:
Single Most Likely Diagnosis
- Acute Anterior Myocardial Infarction (MI): This is the most likely diagnosis due to the location and magnitude of ST segment elevations. Leads V1 to V4 correspond to the anterior wall of the heart, and 3 mm of ST elevation is significant enough to suggest an acute MI.
Other Likely Diagnoses
- Pericarditis: This condition can cause ST segment elevations in multiple leads, including V1 to V4. However, the elevations are typically more widespread and accompanied by other signs such as chest pain and pericardial friction rub.
- Early Repolarization: A benign condition that can mimic ST segment elevations, especially in young individuals. However, the elevations are usually less than 2 mm and accompanied by a distinct J-point notch.
- Myoperant (Takotsubo) Cardiomyopathy: A condition that can cause ST segment elevations and mimic MI, often triggered by emotional or physical stress.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although less likely, a large PE can cause ST segment elevations in leads V1 to V4 due to the ECG pattern known as the "McGinn-White sign" or due to the strain on the right ventricle. Missing this diagnosis can be fatal.
- Aortic Dissection: This is a life-threatening condition that can cause chest pain and ECG changes, including ST segment elevations. Although the ECG findings are not specific, a high index of suspicion is necessary in patients with risk factors.
Rare Diagnoses
- Hypokinesis (Cardiac Sarcoidosis): A rare condition that can cause ST segment elevations due to inflammation and scarring of the heart muscle.
- Myocardial Bridge: A rare congenital condition where a portion of a coronary artery dips into and is surrounded by the myocardium, potentially causing ischemia and ST segment elevations.
- Cardiac Metastasis: Metastatic disease to the heart can cause a variety of ECG abnormalities, including ST segment elevations, although this is exceedingly rare.