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Comment & Response
January 4, 2022

Ventricular Fibrosis Making Waves in ST-segment Elevation—Reply

Author Affiliations
  • 1Department of Cardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi, China
  • 2Department of Electrocardiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi, China
JAMA Intern Med. 2022;182(3):353-354. doi:10.1001/jamainternmed.2021.7553

In Reply We thank An and Chen for their interest and knowledgeable comments on our case report for the Challenges in Clinical Electrocardiography.1 First, the differential diagnosis of acute ST-segment elevation includes acute myocardial infarction, coronary artery spasm, acute pericarditis, hyperkalemia, myocarditis, and pulmonary embolism.2 Often, the shape of ST-segment elevation, the leads involved, other characteristics of electrocardiogram (ECG) results, the clinical environment in which ST-segment elevation occurs, and most importantly, the understanding of pseudomyocardial infarction can help to distinguish among these situations. In addition, imaging examinations, such as echocardiography, are sometimes useful.3 We agree with the point made by An and Chen that acute myocardial infarction can be eliminated through better analysis. However, when patients have new-onset chest distress with ST-segment elevation and cardiac troponin elevation, the diagnosis of acute myocardial infarction is still the primary consideration.4

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