Causes of ST elevation

Six common causes of ST elevation (J point 1mm above the baseline)

• STEMI
• Benign early repolarization (BEP)
• Bundle Branch Block
• Pericarditis
• LV Aneurysm
• Vasospasm

Evaluating for concerning causes of ST elevation: 

1. ​Does the story fit? 
2. Do EKG changes follow an anatomic pattern? BEP should ONLY be in the anterior leads. Any ST changes outside the anterior leads should be investigated further, regardles of morphology. 
3. Is ST elevation morphology typical? STEMI ST elevation typically creates a "frowny face" pattern, unlike BEP, which creates a "happy face" ST segment. 
4. Are there reciprocal changes? PAILS mneumonic (posterior --> anterior, anterior--> inferior, inferior --> lateral, lateral --> septal)
5. Are there changes from a prior EKG? 
6. Are there changes in repeat EKGs?
7. QTc? Narrow QTcs are typically not associated with STEMIs.