ST-segment elevation at the J point in two contiguous ECG leads
- In V2-3 :
- = 0.2 mV in men > 40 years
- = 0.25 mV in men < 40 years
- = 0.15 mV in women in V2-3
- In other leads > 0.1 mV for both sexes
- In V2-3 :
Hyperacute T waves
Hyperacute T waves: are tall, often asymmetrical, broad-based anterior T waves often associated with reciprocal ST depression.
De Winter ST-T complex
De Winter ST-T complex is a ST-segment depression at the J point with ascending ST segment and tall, symmetrical T-waves in the precordial leads, often combined with a 1–2mm elevation of the ST-segment in aVR.
Left bundle branch block or pacemaker rythm with concordant or = 5mm ST elevation. See also (Simplified Sgarbossa criteria)
CAVE: These ECG patterns are not always yet accompanied by chest pain and usually precede overt ST elevation myocardial infarction. They can be interpreted as an early sign of impending coronary occlusion (within 24 hours).
- Type A: Deeply-inverted anterior T waves
- Type B: Biphasic anterior T waves
Left Ventricular Hypertrophy
ST elevation in presence of left ventricular hypertrophy can be tricky to interpret. ST elevation > 25% of QRS amplitude AND [presence of STE in 3 contiguous leads OR presence of T-wave inversions in the anterior leads] is strongly suggestive of acute myocardial infarction.
0.05 mV ST depression in V1-3 especially associated with positive T wave (0.05 mV elevation in V7-9)
J-point depression transitioning in a convex ST segment
Diffuse ST depression
AVR/V1 = 0.1 mV + 8 leads with ST depression = 0.1 mV is moderately suggestive of left main coronary artery occlusion.
Persistent pain despite medical treatment, especially in presence of RBBB or pacemaker rhythm should be regarded as a possible coronary occlusion in absence of a clear alternative explanation
Now you are ready to take the Mini ECG Quiz!