ST segment depression: Difference between revisions
| Line 18: | Line 18: | ||
*Reciprocal changes | *Reciprocal changes | ||
*[[Electrolyte Disorders]] (e.g. [[hypokalemia]]) | *[[Electrolyte Disorders]] (e.g. [[hypokalemia]]) | ||
*SVT | *[[SVT]] | ||
*RBBB/LBBB | *[[RBBB]]/[[LBBB]] | ||
*[[LVH]] with strain pattern (repolarization abnormality) | *[[LVH]] with strain pattern (repolarization abnormality) | ||
*[[Digoxin]] effect (not indicative of toxicity) | *[[Digoxin]] effect (not indicative of toxicity) | ||
Revision as of 11:04, 25 November 2021
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)
- SVT
- RBBB/LBBB
- LVH with strain pattern (repolarization abnormality)
- Digoxin effect (not indicative of toxicity)
- Ventricular paced pattern
See Also
References
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA