ST segment depression

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  • 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

See Also


ST Elevation Lecture, Dr. Niemann, Harbor-UCLA