ST segment depression: Difference between revisions
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== | ==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: <br> | |||
**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== | |||
*[[ECG (Main)]] | |||
==References== | |||
<references/> | |||
ST Elevation Lecture, Dr. Niemann, Harbor-UCLA | ST Elevation Lecture, Dr. Niemann, Harbor-UCLA | ||
[[Category: | [[Category:Cardiology]] |
Revision as of 16:18, 26 September 2019
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