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Elevations of the St Segment of Toxic or
Pharmacologic Origin Simulating
Acute Myocardial Infarction.

Gutiérrez Tirado, Carlos; Bertos Polo, Juan;
Ortega Carnicer, Julián; Martínez Párraga, Prado

Hospital Nª Sª de Alarcos. Ciudad Real. España

Objective: The elevation of the ST segment is the electrocardiographic presentation of transmural myocardial ischemia and constitutes an indispensable requirement to begin thrombolytic therapy in the acute phase of myocardial infarction. We have to bear in mind that some drugs as well as toxics can simulate the electrocardiographic signs of acute myocardial infarction (AMI) so a thorough collection of data and a high index of suspicion are advised in the correct electrocardiogram (ECG) interpretation in the Emergency Room.

Method: Eight cases are presented, 6 males and 2 females, mean age 53.1 21.5 (range 15 ­ 79 years), that showed a transitory ST segment elevation of pharmacological or toxic origin, simulating an AMI.

Results: Three cases were related to fluorine (5­fluorouracile and tegafur as antitumoral drugs; and magnesium fluosilicate, a domestic cleaner). Four more cases were related to the administration of flecainide (for diagnosis of Brugada syndrome), dopamine (in the treatment of urologist sepsis), sodium bicarbonate (iatrogenic) and cocaine (in massive ingestion). Last is a spontaneous bladder rupture with hyperkalemia. The ST segment elevation was located inferolateral in two occasions (25%) and anterior in six (75%). The duration of the ST segment elevation was between 15 minutes and 16 hours. In all the patients there weren't antecedents of coronary disease, the ST segment elevation was transitory, serial CPK were normal and only three cases presented with chest pain. In three patients coronarygraphy was normal.

Conclusions: The interpretation of the ST segment elevation in the ECG requires the history of drugs or toxic substances present, even when there is chest pain, to avoid unnecessary thrombolytic therapy.



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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
Dr. Raúl Bretal
Scientific Committee
Dr. Armando Pacher
Technical Committee - CETIFAC

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