ST segment elevation: Difference between revisions
Mhankerson (talk | contribs) (Edited, minor additions and reformatting) |
(→Source) |
||
| Line 48: | Line 48: | ||
**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 | ||
==See Also== | |||
*[[ECG (Main)]] | |||
*[[ACS - ECG]] | |||
==Source== | ==Source== | ||
Revision as of 03:14, 13 January 2014
Background
- Its presence must be explained (there is no "nonspecific ST elevation")
- Not a specific marker for STEMI
DDX
- Myocardial Infarct (STEMI)
- Wellens' Syndrome
- Coronary spasm (eg, Prinzmetal's angina)
- Drugs (eg, cocaine, crack, meth)
- Pericarditis
- LV aneurysm
- Early repolarization
- LBBB
- LVH
- Misc
- Meds: TCA, digoxin
- RV pacing (appears as LBBB)
- Hyperkalemia
- Hypothermia
- "Osborn J waves"
- Brugada Syndrome
Early Repolarization versus STEMI
- Early Repolarization suggested by:
- ST elevation <4mm
- Notched J point
- Concave or saddle-back ST morphology
- No reciprocal changes
LVH versus STEMI
- Difficult to exclude MI in pt with LVH (pt already at risk for MI)
- Best aid is prior ECG or serial ECGs
LBBB versus STEMI
STEMI
- ST elevation in those leads that reflect the distribution of a single coronary artery
- RCA: II, III, aVF (inferior)
- LAD: V1-V4 (antero-septal)
- Circumflex: V5-V6, I, aVL (lateral)
- Dominant left circulation: infero-lateral
- ST morphology
- Concave up versus convex
- Convex has Sp 97%, Sn 77%
- Concave up versus convex
- Look for reciprocal ST depression
- 35% of anterior STEMI have ST depression in inferior leads
- 80% of inferior STEMI have ST depression in anterior leads
- However, may represent reciprocal changes OR posterior STEMI
See Also
Source
- ST Elevation Lecture, Dr. Niemann, Harbor-UCLA