Tuesday, June 29, 2021

ST elevation

I will share a summary of what I got. Here, I will briefly summarize the ST elevation. I share this because if it is found on ecg, there are details that must be considered.

Ok so let start with the definition of ST elevation.

ST elevation refers to a finding on an ecg where in the trace in the ST segment is abnormality high above the baseline.

Deviation of the ST segment is measured from the end of the QRS complex (point J), or in some cases it can be calculated 40 – 80 ms from point J. This deviation can be elevation, depression, upsloping or downsloping. ST segment elevation is most commonly caused by 3 causes:

  •         Normal variant (early repolarization)
  •         Acute myocardial ischemia (STEMI) or ventricular dyskinesis
  •         Pericarditis



Although not all ST-segment elevations on the ECG are myocardial infarctions, patients with such ECG results should be evaluated for myocardial infarction first before differential diagnosis with other conditions.


ST elevation in myocardial infarction

 ST-segment elevation in myocardial infarction can be seen when point J elevation in the 2 associated leads is >2 mm (0.2 mV) in men or > 1.5 mm (0.15 mV) in women in leads V2–V3 and/or > 1 mm (0.1 mV) in other related leads. Newly developed LBBB can also indicate myocardial infarction, but this is difficult to apply, especially if there is no old ECG for comparison. The finding of hyperacute T waves can be seen early in the occurrence of myocardial infarction.

If the above is not met, here are some features on the ECG that should be suspected of the occurrence of myocardial infarction with ST segment elevation:

  •         T wave disturbance in concomitant leads: T is elongated, inverted or high
  •         Q wave
  •         ST segment depression in reciprocal leads (opposite axis)
  •         ST or T wave amplitude that equals or exceeds the QRS . wave amplitude


Anamnesis, physical examination and investigations (eg cardiac enzymes and echocardiography) as well as referral to a cardiologist are necessary to determine whether the patient has a myocardial infarction or not.If the clinical condition is not consistent with a myocardial infarction, the doctor needs to consider the possibility of this differential diagnosis and also analyze the ECG results more carefully

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