Electrocardiographic ST segment elevation in adults with chest pain.

The accident and emergency (A&E) physician must be an expert in the interpretation of the electrocardiogram (ECG). Patients with chest pain and ST segment elevation on the 12 lead ECG who are experiencing acute myocardial infarction (AMI) may be candidates for urgent coronary revascularisation via either thrombolysis or primary angioplasty. Such treatment, to maximise benefit, must be delivered as early as possible after the onset of infarction. Other such patients with chest pain and electrocar- diographic ST segment elevation may be suffering from a non-coronary chest discomfort syndrome. The correct identification of these patients-both clinically and electro- cardiographically-must be made in order to offer the most appropriate treatments and to avoid potentially dangerous therapies. The A&E doctor is frequently the initial clinician who examines the chest pain patient, interprets the ECG, and makes these early therapeutic decisions. Accurate interpretation of the ECG and the correct diagnosis of AMI among the numerous causes of ST segment elevation is a mandatory skill. The ability of the doctor to correctly interpret the electrocardiographic findings in such patients directly and immedi- ately impacts on management decisions as well as influences patient outcome."A The following discussion focuses on the differential diagnosis Departmnent of