Challenging ST elevation during night shift

• Every ST segment elevation is suspicious of acute myocardial infarction and the diagnosis should be reached in a short time. • Electrolyte imbalance (i.e. hyperkaliemia) and Ph alterations should always be considered. • The treatment of electrolyte imbalance should be performed promptly, even before considering interventional treatments. • Brugada syndrome should be considered as a diagnosis, especially in patients with syncope and a coved type ST elevation in the right precordial leads. • Even a diagnostic type 1 Brugada pattern could be a phenocopy due to electrolyte imbalance. • When Brugada syndrome is presumed and electrolyte imbalance is present, an Ajmaline test is required to confirm the diagnosis.