ST Segement Elevations - Teenager

My 18 year old son was seen at an ER yesterday for chest pain which was worse with deep breathing.  The 12 lead ECG was read as "abnormal" by the NP with ST segment elevations.  A chest x-ray was taken and the results were normal.  The ER doc said that the pain was probably pleurisy and instructed him to take Ibuprofen for the next few days.  Should I have my doctor refer my son to a cardiologist to repeat the ECG, or is it likely that the ST segment elevations were entirely normal?

[Jack54]

I have these to so show up from time to time on my EKGs. Here is some info I found. The ER doc should probably have known to tell you that it can be normal for a young adult male.

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ST segment elevation

ST segment elevation is usually attributed to impending infarction, but can also be due to pericarditis or vasospastic (variant) angina. In some healthy young adults, a form of ST elevation can be normal.

Causes of ST Elevation:
Infarction
Vasospastic angina
Pericarditis
Early repolarization



*Infarction:

In transmural infarction, ST segment elevation will be among the first manifestations. The ST segment elevation will be seen in those leads involved in impending infarction.

ST segment elevation decreases as T wave inversion begins. ST segments may remain elevated when ventricular aneurysm develops.

ST segment elevation that persists beyond three months following myocardial infarction suggests ventricular aneurysm. ST elevation will be present in about 1/3 of ventricular aneurysms. When the patient with ventricular aneurism (aneurysm) presents with acute chest pain, a baseline ECG may help avoid misdiagnosis of impending infarction (and use of non-needed thrombolytic drugs).

*Vasospastic angina:

ST segment elevation can be seen in a severe type of ischemia called vasospastic or Prinzmetal’s angina. While exercise angina involves the subendocardium, vasospastic angina causes severe transmural loss of blood flow. ST elevation simply indicates injury, whether due to coronary thrombosis with impending infarction, or coronary spasm (Prinzmetal’s angina). At this point, the injury is reversible.

*Pericarditis:

Pericarditis, an inflammation of the space between the pericardial sack and outer surface of the heart, causes widespread ST segment elevation. Physical damage and irritation of the heart’s surface produces a “current of injury” in virtually all ECG leads.

Generalized ST segment elevation, unrelated to the distribution of any coronary artery, implies pericarditis. One must be very cautious in diagnosing pericarditis from the ECG. For example, an inferolateral transmural infarction with pre-existing junctional ST elevation in the anterior leads, could produce widespread ST elevation that could be confused with pericarditis.

Later in the course of pericarditis, ST segment elevation resolves, without development of Q waves. After days to months, ST elevation is replaced by widespread T wave inversions.

*Early repolarization:

“Early repolarization” is a cause of ST elevation. This innocent condition typically occurs in young healthy males. The T wave begins early, adding elevation to the ST segment.

[Kacey64]

Thanks for the information, I appreciate your help.