ELEKTROKARDIOGRAM YANG MENYERUPAI ELEVASI SEGMEN ST: SUATU DIAGNOSIS BANDING
A COMPARATIVE REVIEW OF THE DIFFERENTIAL DIAGNOSIS OF ST-SEGMENT ELEVATION ON ELECTROCARDIOGRAM
Keywords:
IMAEST, elevasi segmen ST, penyebab non iskemik, EKG
Abstract
Infark miokard akut dengan peningkatan segmen ST (IMAEST) merupakan oklusi total pembuluh darah koroner yang harus diatasi segera dengan tatalaksana intervensi secara farmakologi atau perkutan, dimana penegakan diagnosis dalam waktu 10 menit sudah dapat dilakukan dengan pemeriksaan elektrokardiogram (EKG). Namun, terdapat gambaran EKG lain yang menyerupai IMAEST sehingga diperlukan pengetahuan dokter untuk melakukan diagnosis. Gambaran tersebut dinamakan elevasi segmen ST non iskemik, dimana dapat berupa radang perikard atau miokard (pericarditis/miokarditis), kardiomiopati takotsubo, sindroma Brugada, repolarisasi dini, blok cabang berkas kiri, irama pacu jantung ventrikel kanan, hipertrofi ventrikel kiri dan hiperkalemia. Diharapkan para dokter dapat melakukan penegakan diagnosis yang tepat dari IMAEST dengan melihat gambaran EKG yang menyerupai elevasi segmen ST ini.
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2. Laksono S. INTERPRETASI EKG NORMAL PRAKTIS BAGI PEMULA: SUATU TINJAUAN MINI. JURNAL KEDOKTERAN. 2021;7(1):1. doi:10.36679/kedokteran.v7i1.408
3. Riley RF, McCabe JM. ST-segment Elevation Myocardial Infarction: Challenges in Diagnosis. US Cardiology Review. Published online 2016. doi:10.15420/usc.2016:5:2
4. Klabunde RE. Cardiac electrophysiology: normal and ischemic ionic currents and the ECG. Adv Physiol Educ. 2017;41(1):29-37. doi:10.1152/advan.00105.2016
5. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39(2):119-177. doi:10.1093/eurheartj/ehx393
6. Domienik-Karłowicz J, Kupczyńska K, Michalski B, et al. Fourth universal definition of myocardial infarction. Selected messages from the European Society of Cardiology document and lessons learned from the new guidelines on ST-segment elevation myocardial infarction and non-ST-segment elevation-acute coronary syndrome. Cardiol J. 2021;28(2):195-201. doi:10.5603/CJ.a2021.0036
7. Pendell Meyers H, Bracey A, Lee D, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. IJC Heart & Vasculature. 2021;33:100767. doi:10.1016/j.ijcha.2021.100767
8. Buttà C, Zappia L, Laterra G, Roberto M. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Annals of Noninvasive Electrocardiology. 2020;25(3). doi:10.1111/anec.12726
9. Mangini F, Biederman RW. Reconsideration of the ECG in pericarditis; have we been led astray all these years? Heart & Lung. 2022;52:170-173. doi:10.1016/j.hrtlng.2021.12.005
10. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo Syndrome. Circulation. 2017;135(24):2426-2441. doi:10.1161/CIRCULATIONAHA.116.027121
11. Ancona F. The dynamic of ECG in Takotsubo Syndrome and myocardial infarction: the long quest for an intriguing non-invasive differential diagnosis between ischemic syndromes. Int J Cardiol. 2021;322:46-48. doi:10.1016/j.ijcard.2020.09.012
12. Othieno AA, Isaacs DJ, Vinson DR, Levis JT. ECG Diagnosis: Brugada Syndrome. Perm J. 2019;23(4). doi:10.7812/TPP/19.044
13. Vitali F, Brieda A, Balla C, et al. Standard ECG in Brugada Syndrome as a Marker of Prognosis: From Risk Stratification to Pathophysiological Insights. J Am Heart Assoc. 2021;10(10):e020767. doi:10.1161/JAHA.121.020767
14. Nakashima T, Nagase M, Shibahara T, et al. True Brugada syndrome ECG or Brugada phenocopy ECG? Can the ECG itself tell us the diagnosis? J Electrocardiol. 2022;73:59-61. doi:10.1016/j.jelectrocard.2022.05.009
15. Viskin S, Chorin E, Rosso R, Amin AS, Wilde AA. Diagnosis of Brugada Syndrome With a Sodium-Channel-Blocker Test: Who Should Be Tested? Who Should Not? Circulation. 2024;150(8):642-650. doi:10.1161/CIRCULATIONAHA.124.069138
16. Boyden PA. Purkinje physiology and pathophysiology. J Interv Card Electrophysiol. 2018;52(3):255-262. doi:10.1007/s10840-018-0414-3
17. Patton KK, Ellinor PT, Ezekowitz M, et al. Electrocardiographic Early Repolarization. Circulation. 2016;133(15):1520-1529. doi:10.1161/CIR.0000000000000388
18. Meyers HP, Limkakeng AT, Jaffa EJ, et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015;170(6):1255-1264. doi:10.1016/j.ahj.2015.09.005
19. Hanna EB, Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleve Clin J Med. 2015;82(6):373-384. doi:10.3949/ccjm.82a.14026
20. Bula K, Bisaga J, Feret B, et al. Electro‐ and echocardiographic features of left ventricle hypertrophy in patients with hypertrophic cardiomyopathy. Annals of Noninvasive Electrocardiology. 2022;27(5). doi:10.1111/anec.12992
21. Aro AL, Chugh SS. Clinical Diagnosis of Electrical Versus Anatomic Left Ventricular Hypertrophy. Circ Arrhythm Electrophysiol. 2016;9(4). doi:10.1161/CIRCEP.115.003629
22. Varga C, Kálmán Z, Szakáll A, et al. ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients. BMC Emerg Med. 2019;19(1):33. doi:10.1186/s12873-019-0247-0
Published
2025-06-25
Section
Tinjauan Pustaka
Copyright (c) 2025 Sidhi Laksono
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
