ST segment depression: Difference between revisions
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==Diagnosis== | |||
*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 | ||
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**down sloping pattern | **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== | ==See Also== | ||
Revision as of 04:46, 25 February 2015
Diagnosis
- 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
Source
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA