Further Cardiac Causes

Further, less common cardiac causes are listed below.

Ventricular aneurysm

The majority of ventricular aneurysms are seen after large anterior myocardial infarctions [14]. This diagnosis may be indicated by the clinical history and the presence of previously recorded discharge ECGs.

The most common site of ST segment elevation is in the anterior leads reflecting the most likely site of the original STEMI. Clinical and ECG features will be static unlike those of a patient presenting with an acute STEMI. The other ECG characteristics are shown in Table 1.

Table 1: ECG characteristics of Ventricular Aneurysm

Ventricular Aneurysm

Height of ST elevation


ST morphology

Any shape

ST site

More common anteriorly

T wave

Diminished in size

Q waves

Present in the STEMI distribution

Brugada syndrome

This is a rare but serious cause of ST segment elevation without AMI. It is an autosomal dominant condition with incomplete penetrance that has an incidence ranging from 5 to 66 per 10 000. It is endemic in Southeast Asia [13].

Clinical features include: episodes of arrhythmia (usually rapid polymorphic VT), collapse or sudden death. The episodes are more common in the night or the early hours of the morning. There may be a family history of sudden death. It has a male predominance (ratio 8:1).

There are three types, each with specific ECG appearances. These ECG findings can be dynamic and can be unmasked or exaggerated by sodium channel blockers such as flecainide. Brugada syndrome is not associated with identifiable structural cardiac abnormalities.

ST Segment elevation occurs in the right precordial leads V1 to V3. The exact morphology of the ST segment gives rise to the three types, see Table 2.

Table 2: ECG characteristics for Brugada syndrome

ST elevation characteristic

T wave characteristic

Type 1

ST elevation slopes downward

Inverted T wave

Type 2

High take off ST elevation >2mm Saddle Shape

Upward/ biphasic T wave remaining 1mm above baseline

Type 3

Less ST elevation Saddle shape

Upward T wave

ST elevation generally persists approx. 2/52. Persistence thereafter could represent Ventricular Aneurysm

Image supplied by Life in the Fast lane