ST Segment Elevations in ECG

ST Segment Elevations in ECG K.S. Chew School of Medical Sciences Universiti Sains Malaysia

Introduction ,[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]

Causes of ST Segment Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acute Myocardial Infarction ,[object Object],[object Object]

Acute Myocardial Infarction ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],TP segment or PR segment?

ST Segment Elevation Requirements ,[object Object],1 mm: I,II,III, aVL, aVF, V5-6 2mm: V1-V4 1 Minnesota Code 1 1 2 TAMI 1 1 2 TIMI 2 1 2 GUSTO 2 1 1 GISSI-2 2 1 1 GISSI-1 1 1 2 AHA/ACC Minimum ST Elevation (mm) Precordial leads Minimum ST Elevation (mm) Limb leads Minimum Consecutive Leads Study

Minnesota Code ,[object Object],[object Object]

[object Object],[object Object],Acute Myocardial Infarction

How To Differentiate STE due to AMI from Other Causes? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Morphology of the ST Elevation

Variable Shapes Of ST Segment Elevations in AMI Goldberger AL. Goldberger: Clinical Electrocardiography: A Simplified Approach. 7th ed: Mosby Elsevier; 2006.

Morphology of STE ,[object Object],[object Object],J point Apex of T wave Concave STE Convex STE

Benign Early Repolarization Notching or slurring of J point Concave STE Large amplitude T wave

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Benign Early Repolarization

Distribution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pericarditis Goldberger AL. Goldberger: Clinical Electrocardiography: A Simplified Approach. 7th ed: Mosby Elsevier; 2006.

[object Object],[object Object],[object Object],[object Object],Differentiating ECG Changes of AMI vs Pericarditis

[object Object],[object Object],Pericarditis

Acute Pericarditis – Four Classical Stages ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Stage 1 Pericarditis PR Depression

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ECG Changes of Pericarditis vs Benign Early Repolarization

Brugada Syndrome: ECG patterns ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ST Elevation morphologies in Brugada Syndrome RBBB with RSR pattern rather than rSR pattern and there is associated STE

Left Bundle Branch Block ,[object Object],[object Object],[object Object]

Sgarbossa Criteria ,[object Object],[object Object]

Sgarbossa Criteria Odds Ratio: a measure of the degree of association; for example, the odds of exposure among the cases compared with the odds of exposure among the controls (www.cefpas.it/ebm/tools/glossary.htm) Score 2 points OR 4.3 ST Elevation ≥ 5 mm and discordant with QRS complex Score 3 points OR 6.0 ST Depression ≥ 1 mm in V1, V2, V3 Score 5 points Odds Ratio (OR) 25.2 ST Elevation ≥ 1 mm and concordant with QRS complex

[object Object],[object Object],[object Object],Sgarbossa Criteria

ECG Diagnostic Criteria for LVH Other Criteria include Romhilt and Estes Point Score System ,[object Object],100 11 R in aVL> 11mm 100 11 R1 + SIII>25 mm 96 42 Cornell Voltage Criteria SV3+RaVL>28 mm (men), 20mm(women) 100 22 Sokolow-Lyon Index SV1 + (RV5 or RV6)>35mm Specificity Sensitivity

[object Object],[object Object],ECG Changes of Left Ventricular Hypertrophy vs AMI

Conclusion ,[object Object],[object Object],[object Object]

References ,[object Object],[object Object]

References ,[object Object],[object Object],[object Object]

ST Segment Elevations in ECG

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ST Segment Elevations in ECG