The Vitals: Causes of ST Elevation

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Shyam Murali
Shyam Murali
Fellow in Trauma and Surgical Critical Care - University of Pennsylvania, Senior Editor -, Writer -, Saxophonist, EDM remixer, husband, puppy father, and new human father

The Pre-brief

One of my favorite attendings and ECG expert, Dr. de Saint Victor (AKA dSV), makes use of spaced repetition to help us remember the many causes of ST elevation. As a standing segment of all of his lectures, his list of 18 causes of ST elevation have been drilled into our minds. Of note, only ONE of these is myocardial infarction! In this previous Vitals post, we covered causes of troponin elevation; today we are going to cover the causes of ST elevation.

Causes ST elevation:

  • The Usual Suspects
    • STEMI
    • Vasospasm
    • Pericarditis/myocarditis
    • Benign early repolarization
  • Lefties and Righties
    • Left bundle branch block
    • Left ventricular aneurysm
    • Left ventricular hypertrophy
    • Pulmonary embolism, right heart strain
  • H’s
    • Hyperkalemia
    • Hypercalcemia
    • Hypothermia
    • Na+ cHannelopathies
  • Names
    • Brugada syndrome
    • Takotsubo cardiomyopathy
  • Disasters (Spiked helmet sign)
    • Intracranial abnormalities
    • Post-cardioversion/post-epinephrine
    • Aortic dissection
    • Massive GI bleed
Spiked helmet sign
STEMI mimics

The Debrief

Consider dividing up the causes of ST elevation into the following categories:

  • The Usual Suspects
  • Lefties and Righties
  • H’s
  • Names
  • Disasters


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