ST segment depression: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Contour: | *Contour: Most→Least concerning for ischemia: Planar/Flat (90%) → Concave up (33%) → Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern) | ||
*Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise | *Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise | ||
*Indicators of ischemia: | *Indicators of ischemia: | ||
Revision as of 18:05, 8 February 2017
Evaluation
- Contour: Most→Least concerning for ischemia: Planar/Flat (90%) → Concave up (33%) → Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern)
- Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise
- Indicators of ischemia:
- >0.5mm depression from baseline (especially >1mm) in two or more contiguous leads
- Transient depression
- Morphology that is flat or downsloping
- Strain:
- tall R wave
- only in lateral leads (not anterior)
- "checkbox" or asymmetric TWI
- down sloping pattern
Differential Diagnosis
- Posterior MI (including posterior STEMI)
- RV strain
- NSTEMI
- Reciprocal changes
- Electrolyte Disorders (e.g. hypokalemia)
- LVH with strain pattern (repolarization abnormality)
- Digoxin effect (not indicative of toxicity)
See Also
References
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA