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Test Findings
 
 

ST Elevation

 
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Overview

ST elevation is classically associated with ST elevation myocardial infarction (STEMI) and as such is a medical emergency if seen on ECG. However, there are several other causes of ST elevation that it is important to be aware of.
  • Look For

    Elevation of the J point (meeting point of the QRS complex and ST segment)
  • >2mm in V1-V3
  • >1mm in limb leads
  • ST Elevation
     
  • Causes of ST Elevation

  • ST elevation myocardial infarction
  • Prinzmetal angina (coronary vasospasm)
  • Tako-tsubo cardiomyopathy
  • Pericarditis
  • Left bundle branch block
  • Left ventricular hypertrophy
  • Benign early repolarisation (physiological)
  • Subarachnoid haemorrhage
  • Interpretation

  • Localised ST elevation with reciprocal ST depressionST elevation myocardial infarction, prinzmetal angina, tako-tsubo cardiomyopathy
  • ST elevation discordant with the QRS complexLeft bundle branch block, left ventricular hypertrophy
  • Mild concave ST elevation with tall T waves in at least 1 precordial lead ± notch at end of QRS complex (j-point notching)Benign early repolarisation
  • Widespread ST elevationPericarditis, subarachnoid haemorrhage, tako-tsubo cardiomyopathy
  • Examples

  • Benign early repolarisation with concave ST elevation, tall T waves and J-point notching:
  • ST Elevation
Massive ST elevation (“tombstoning” pattern) associated with large MI:
  • ST Elevation
     
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