ST segment depression: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Source==" to "==References== <references/>") |
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
||
| Line 1: | Line 1: | ||
== | ==Evaluation== | ||
*Contour: Most-->Least concerning for ischemia: Planar/Flat (90%) --> Concave up (33%) --> Downsloping with Asymmetric inverted T-wave (not ischemic/strain pattern) | *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 | ||
Revision as of 10:39, 25 July 2016
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