ST-elevation

(NEJM 2003;349:2128; Circ 2009;119:e241 & e262)

參考 ➡️ AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a …

參考 ➡️ ST-segment elevation in conditions other than acute myocardial infarction

• Acute MI: upward convexity STE (ie, a “frown”) ± TWI (or prior MI w/ persistent STE)

• Coronary spasm: Prinzmetal’s angina; transient STE in a coronary distribution

• Pericarditis: diffuse, upward concavity STE (ie, a “smile”); a/w PR ↓; Tw usually upright

• HCM, Takotsubo CMP, ventricular aneurysm, cardiac contusion

• Pulmonary embolism: occ. STE V1–V3; classically a/w TWI V1–V4, RAD, RBBB, S1Q3T3

• Repolarization abnormalities:

LBBB (↑ QRS duration, STE discordant from QRS complex; see “ACS” for dx MI in LBBB)

LVH (↑ QRS amplitude); Brugada syndrome (rSR′, downsloping STE V1–V2); pacing

Hyperkalemia (↑ QRS duration, tall Ts, no P’s); epsilon waves (late afterdepol.) in ARVC

• aVR: STE >1 mm a/w ↑ mortality in STEMI; STE aVR > V1 a/w left main disease

• Early repolarization: most often seen in V2–V5 in young adults (Circ 2016;133:1520)

1–4 mm elev of notch peak or start of slurred downstroke of R wave (ie, J point); ± up concavity of ST & large Tw (∴ ratio of STE/T wave <25%; may disappear w/ exercise)

? early repol in inf leads may be a/w ↑ risk of VF (NEJM 2009;361:2529; Circ 2011;124:2208)

• Post-ROSC: transient STE can be seen w/in 1st ~8 mins; not indicative of ACS