ST segment depression

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
  • ECG (Main)

References

    ST Elevation Lecture, Dr. Niemann, Harbor-UCLA

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