Examine  the ECG provided below

a)  Describe the abnormalities on the ECG

b)  List 2 potential causes

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College Answer

a)  Describe the abnormalities on the ECG
Tachycardia
Intraventricular conduction defect probably RBBB Widespread ST elevation

b)  List 2 potential causes
Acute myocardial infarction (extensive)
Maybe myopericarditis

Discussion

There is little to discuss. There are many potential causes for ST elevation, but fewer for ST elevation with bundle branch block. I can think of only the following:

  • Myocardial infarction
  • Cardiac contusion
  • Acute myocarditis
  • LV aneurysm
  • Hyperkalemia
  • Pulmonary embolism
  • Early repolarization (with elevated J point)
  • Left bundle branch block
  • Hypothermia with J point elevation (can be mistaken for ST elevation)
  • Brugada syndrome (characteristic ST changes can be mistaken for STEMI)

References

References

The above ECG was borrowed gratefully from the STEMI collection at LITFL. Unfortunately there is no tachycardia, but the spirit of the question is preserved I hope.

There is an excellent paper to help you generate differentials about ST segment changes: Wang, Kyuhyun, Richard W. Asinger, and Henry JL Marriott. "ST-segment elevation in conditions other than acute myocardial infarction." New England Journal of Medicine 349.22 (2003): 2128-2135.