ST segment elevation - Revision history

Rossdonaldson1: /* STEMI */

2019-04-06T13:37:13Z

STEMI

← Older revision		Revision as of 13:37, 6 April 2019
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	**80% of inferior STEMI have ST depression in anterior leads		**80% of inferior STEMI have ST depression in anterior leads
	***However, may represent reciprocal changes '''OR''' posterior STEMI		***However, may represent reciprocal changes '''OR''' posterior STEMI

	~~{{STEMI Stages of Development}}~~

	====Reciprocal Changes====		====Reciprocal Changes====
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	#**Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI		#**Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI
	#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)		#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)

			{{STEMI Stages of Development}}

	==Management==		==Management==

Rossdonaldson1: /* STEMI */

2019-04-06T13:35:24Z

STEMI

@@ Line 42: / Line 42: @@
 ***However, may represent reciprocal changes '''OR''' posterior STEMI
-====[[STEMI]] Stages of Development====
+{{STEMI Stages of Development}}
 ====Reciprocal Changes====

Rossdonaldson1: /* Stages of Development */

2019-04-06T13:34:28Z

Stages of Development

← Older revision		Revision as of 13:34, 6 April 2019
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	***However, may represent reciprocal changes '''OR''' posterior STEMI		***However, may represent reciprocal changes '''OR''' posterior STEMI

	====Stages of Development====		====[[STEMI]] Stages of Development====
	{\| {{table}}		{\| {{table}}
	\| align="center" style="background:#f0f0f0;"\|'''Stage'''		\| align="center" style="background:#f0f0f0;"\|'''Stage'''

Rossdonaldson1: /* Stages of Development */

2019-04-06T13:34:14Z

Stages of Development

← Older revision		Revision as of 13:34, 6 April 2019
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	[[File:STEMI-d2.jpg\|70px]]		[[File:STEMI-d2.jpg\|70px]]
	\|}		\|}
	~~[[Image:STEMI Progression.jpg]]~~

	*a: 30min after chest pain onset
	*b: 45min after chest pain onset (hyperacute T waves)
	*c: 70min after chest pain onset (ST elevation)
	*d: 3hr after PCI (ST segment has decreased, TWI incdicates reperfusion)
	*e: 5 days after PCI (ST segment back to baseline, TWI is near baseline)

	====Reciprocal Changes====		====Reciprocal Changes====

Rossdonaldson1: /* Stages of Development */

2019-04-06T13:33:54Z

Stages of Development

← Older revision		Revision as of 13:33, 6 April 2019
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	\| 3\|\|Within 1hr; completed within 8-12hr \|\|Q waves \|\|Persist indefinitely in 70% of cases		\| 3\|\|Within 1hr; completed within 8-12hr \|\|Q waves \|\|Persist indefinitely in 70% of cases
	\|		\|
	[[File:STEMI-d.jpg\|70px]]		[[File:STEMI-d2.jpg\|70px]]
	\|}		\|}
	[[Image:STEMI Progression.jpg]]		[[Image:STEMI Progression.jpg]]

Rossdonaldson1: /* Stages of Development */

2019-04-06T13:28:36Z

Stages of Development

← Older revision		Revision as of 13:28, 6 April 2019
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	\| align="center" style="background:#f0f0f0;"\|'''Finding'''		\| align="center" style="background:#f0f0f0;"\|'''Finding'''
	\| align="center" style="background:#f0f0f0;"\|'''Duration'''		\| align="center" style="background:#f0f0f0;"\|'''Duration'''
			\| align="center" style="background:#f0f0f0;"\|'''ECG'''
	\|-		\|-
	\| 1\|\|30min - hours \|\|Hyperacute T waves		\| 1\|\|30min - hours \|\|Hyperacute T waves
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	*>10mm precordial leads		*>10mm precordial leads
	\|\|Normalizes in days, weeks, or months		\|\|Normalizes in days, weeks, or months
			\|
			[[File:STEMI-b.jpg\|70px]]
	\|-		\|-
	\| 2\|\|Minutes - hours \|\|ST segment elevation		\| 2\|\|Minutes - hours \|\|ST segment elevation
	*0.1mV in two or more contiguous leads		*0.1mV in two or more contiguous leads
	\|\|ST segment resolution occurs over 72hrs; completely resolves within 2-3wks		\|\|ST segment resolution occurs over 72hrs; completely resolves within 2-3wks
			\|
			[[File:STEMI-c.jpg\|70px]]
	\|-		\|-
	\| 3\|\|Within 1hr; completed within 8-12hr \|\|Q waves \|\|Persist indefinitely in 70% of cases		\| 3\|\|Within 1hr; completed within 8-12hr \|\|Q waves \|\|Persist indefinitely in 70% of cases
			\|
			[[File:STEMI-d.jpg\|70px]]
	\|}		\|}
	[[Image:STEMI Progression.jpg]]		[[Image:STEMI Progression.jpg]]

Rossdonaldson1: /* Stages of Development */

2019-04-06T13:20:09Z

Stages of Development

← Older revision		Revision as of 13:20, 6 April 2019
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	====Stages of Development====		====Stages of Development====
	*Stage 1		{\| {{table}}
	**Timing: 30min - hours		\| align="center" style="background:#f0f0f0;"\|'''Stage'''
	**Finding: hyperacute T waves		\| align="center" style="background:#f0f0f0;"\|'''Timing'''
	***>6mm limb leads		\| align="center" style="background:#f0f0f0;"\|'''Finding'''
	***>10mm precordial leads		\| align="center" style="background:#f0f0f0;"\|'''Duration'''
	**Duration: normalizes in days, weeks, or months		\|-
	*Stage 2		\| 1\|\|30min - hours \|\|Hyperacute T waves
	**Timing: minutes - hours		*>6mm limb leads
	**Finding: ST segment elevation		*>10mm precordial leads
	***≥0.1mV in two or more contiguous leads		\|\|Normalizes in days, weeks, or months
	**Duration: ST segment resolution occurs over 72hrs; completely resolves within 2-3wks		\|-
	*Stage 3		\| 2\|\|Minutes - hours \|\|ST segment elevation
	**Timing: within 1hr; completed within 8-12hr		*0.1mV in two or more contiguous leads
	**Finding: Q waves		\|\|ST segment resolution occurs over 72hrs; completely resolves within 2-3wks
	**Duration: persist indefinitely in 70% of cases		\|-
			\| 3\|\|Within 1hr; completed within 8-12hr \|\|Q waves \|\|Persist indefinitely in 70% of cases
			\|}
	[[Image:STEMI Progression.jpg]]		[[Image:STEMI Progression.jpg]]

Rossdonaldson1: /* Evaluation */

2019-04-06T13:08:43Z

Evaluation

← Older revision		Revision as of 13:08, 6 April 2019
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	[[File:597px-Stelevatie en.png\|thumb\|Measure ST elevation at the j-point<ref>Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O'Reilly MG, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, and Smith SC Jr. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002 Oct 1; 106(14) 1883-92. pmid:12356646.</ref>]]		[[File:597px-Stelevatie en.png\|thumb\|Measure ST elevation at the j-point<ref>Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O'Reilly MG, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, and Smith SC Jr. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002 Oct 1; 106(14) 1883-92. pmid:12356646.</ref>]]

	===Early Repolarization versus STEMI===		===Early Repolarization versus [[STEMI]]===
	*Early Repolarization suggested by:		*Early Repolarization suggested by:
	**ST elevation <4mm		**ST elevation <4mm
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	**Young patient without risk factors		**Young patient without risk factors

	===LVH versus STEMI===		===[[LVH]] versus [[STEMI]]===
	*Difficult to exclude MI in patient with LVH (patients with LVH are already at risk for MI)		*Difficult to exclude MI in patient with LVH (patients with LVH are already at risk for MI)
	*Best aid is prior ECG or serial ECGs		*Best aid is prior ECG or serial ECGs

	===LBBB versus STEMI===		===[[LBBB]] versus [[STEMI]]===
	See [[Sgarbossa's Criteria]]		See [[Sgarbossa's Criteria]]

Rossdonaldson1: /* Evaluation */

2019-04-06T13:05:12Z

Evaluation

← Older revision		Revision as of 13:05, 6 April 2019
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	#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)		#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)

	==Management		==Management==

	==Disposition==		==Disposition==

Rossdonaldson1 at 13:04, 6 April 2019

2019-04-06T13:04:45Z

← Older revision		Revision as of 13:04, 6 April 2019
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	==Background==		==Background==
	*Its presence must be explained (there is no "nonspecific ST elevation")		*Its presence must be explained (there is no "nonspecific ST elevation")
	*Not a specific ~~marker for~~ STEMI		*Not specific only to [[STEMI]]

			==Clinical Features==
			*Depends on underlying etiology

	==Differential Diagnosis==		==Differential Diagnosis==
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	#**Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI		#**Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI
	#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)		#*Often associated with ST-segment elevation in II, III, aVF (inferior involvement)

			==Management

			==Disposition==

	==See Also==		==See Also==