Contents

Search

ST segment depression

Depression of the ECG ST segment. Etiology: 1) subendocardial injury (myocardial ischemia) 2) may occur as reciprocal ST segment depression in conjunction with ST segment elevation in other leads 3) left ventricular hypertrophy (ST-segment depression & T-wave inversion) - R wave in lead aVL is >= 11 mm [2] Laboratory: - serum troponin I Special laboratory: - electrocardiogram: a) ST segment depression b) 0.5 mm in 2 or more contiguous leads is significant Management: - defines high cardiac risk patients - in conjunction with chest pain treat as NSTEMI - administer P2Y12 inhibitor & heparin in high risk patients - LMW heparin if normal kidney function, otherwise unfractionated heparin [3] - patient should have received aspirin - nitrates as needed for angina pectoris - add beta-blocker as tolerated - admit to hospital - assess TIMI score - urgent percutaneous coronary intervention in high-risk patients [2] - even in the absence of elevated cardiac troponin [2] - not indicated within 6 hours in the absence of ST segment elevation or LBBB [2] - delayed percutaneous coronary intervention (within 72 hours) in intermediate-risk patients [2] - cardiac stress testing in low-risk patients [2]

Related

ECG changes in myocardial ischemia ST segment elevation

General

ECG ST segment

Figures/Diagrams

EKG: ST depression

References

  1. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  3. NEJM Knowledge+