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ST segment elevation
Elevation of the ECG ST segment.
Also see ST segment elevated myocardial infarction.
Etiology:
1) myocardial ischemia
a) acute coronary syndrome
b) myocardial infarction (MI)
2) transmural or subepicardial injury
- left ventricular aneurysm
- cardiomyopathy
- stress cardiomyopathy (broken heart syndrome)
3) pericarditis
a) diffuse, convave upward
b) no reciprocal ST segment depression
4) coronary vasospasm
5) acute stroke [2]
6) severe hypercalcemia [2]
7) occasionally in healthy young African-American men
Pathology:
- associated with fibrin deposition, thus the indication for fibrinolytic therapy
Special laboratory:
- electrocardiogram
- 1 mm in 2 contiguous leads is considered significant elevation
- ST segment elevation in ECG leads II, III -> inferior wall MI
- obtain right sided leads to assess right ventricular MI
- ST segment elevation in right-sided lead V4 (V4R) is the most sensitive indicator for right ventricular MI
- ST segment elevation in ECG leads V1-V4 -> anterior wall MI
* ST segment elevation surrogates:
- new left bundle-branch block (LBBB)
- tall R & ST segment depression in leads V1-V4 (posterior wall MI) [2]
Differential diagnosis:
- pericarditis
a) diffuse ST segment elevation
b) diffuse PR interval depression
- left ventricular wall aneurysm
- normal variant [2]
Related
ECG changes in myocardial ischemia
ST segment depression
ST segment elevated myocardial infarction (STEMI)
General
ECG ST segment
Figures/Diagrams
EKG: ST segment elevation with reciprocal depression
References
- ACLS - The Reference Texbook
ACLS: Principles & Practice, Cummins RO et al (eds),
American Heart Association, 2003 ISBN 0-87493-341-2
- Medical Knowledge Self Assessment Program (MKSAP) 14, 19.
American College of Physicians, Philadelphia 2006, 2022
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022