Concerning ST Elevations

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Presentation transcript:

Concerning ST Elevations Steve Lan Aug 21,2003

Objective Concerning ST elevation vs benign ST changes Remember: history, exam, labs, serial ECGS Disclaimer: everyone has their own interpretation

Outline Review Differential Examples and Comparisons Conclusions

Tombstones

The Basics Measure 0.04s after J point

Trouble: Sharp vs Diffuse J point

Differential Acute MI (15%) LVH with Strain (25%) LBBB (15%) Early repolarization (12%) LV aneurysm (3%) Pericarditis (1%) undefined (17%) Brady WJ et al. Cause of ST Segment Abnormality in ED Chest Pain Patients. Am J Emerg Med 2001; 19: 25-28.

Quick Examples Concave up = usually “good” Concave down = usually “bad”

Additional information: T waves As always look at the whole picture reciprocal changes

Bad ST changes: Ischemia, Injury, Infarct

Evolution of Acute MI

Bad??

Not good??

Strain vs Infarction

LVH + Strain

Anteroseptal MI

Early Repolarization ST elevation in percordial concave up may have reciprocal depression aVR tall, peaked, assymetric T waves younger (<50), good health incidence 1-2% Mehta, et al. Early Repolarization. Clin.Cardiol. 1999; 22, 59-65

Early Repolarization

Comparison

Pericarditis Stage 1 (day 2-3, lasting up to 2 wks) Concave up diffuse ST elevation ST/T wave ratio > .25 in pericarditis < .25 in early repolarization no reciprocal changes

Pericarditis example

LBBB

Summary Not all ST elevations are equal Look for the company it keeps Hx and physical T waves, reciprocal changes Concave up - usually ok Concave down - usually bad

References Brady WJ et al. Cause of ST Segment Abnormality in ED Chest Pain Patients. Am J Emerg Med 2001; 19: 25-28. 12- Lead ECG: The Art of interpretation. Garcia, Holtz. http://www.fpnotebook.com http://medlib.med.utah.edu/kw/ecg http://www.sun.ac.za/internal/scripts/ecgs.asp