- Patient having typical cardiac chest pain and ECG showing ST segment
elevations in anterior leads but isoelectric ST segment
in inferior leads may represent ischaemia extending to entire inferior territory.
The associated ST segment
usually shows as upward convexity.
Diagnostic criteria for de Winter pattern are: tall, prominent, symmetrically peaked T-waves in the precordial leads, upsloping ST segment
depression > 1 mm at the J-point in the precordial leads, absence of ST elevation in the precordial leads, ST segment
elevation (0.5 mm-1 mm) in aVR.
We used WHO calculator for sample size and included consecutive 960 patients with ST segment
elevation Myocardial infarction presented in emergency department for one year from Jan 2016 to Dec 2016.
In conditions with short PR interval like sinus tachycardia, the [T.sub.a] wave can blend into the ST segment
and cause ST segment
depression mimicking myocardial ischemia.
Typical ECG ST segment
elevations vary in amplitude and morphology and they have been known to be transient, making the diagnosis more difficult.
ECG revealed ST segment
elevation in leads D1, D2, aVL, aVF, V3, V4, V5, and V6 (Figure 1).
* Type 1 consists of coved-type ST segment
elevation of [greater than or equal to] 2 mm followed by a negative T wave.
24 hour ECG Holter monitoring has shown stable sinus rhythm with an average of 67 beats per minute (minimum of 60 beats per minute and maximum 87 beats per minute), diffuse variable ST segment
depressions and negative T waves, rare and isolated supraventricular and ventricular ectopic beats, with uniform distribution between active and passive periods.
Elevated ST segments
in V4R or V3R to V6R can be used to diagnose RVI.
The most prominent and consistent response to ischemia in the electrocardiogram (ECG) during exercise is ST depression; however the wide variability in the pattern of ST changes and the significant rate of false positive and false negative findings demand that clear understanding of the ST segment
changes appearing during stress is necessary for proper interpretation of the test result.
The ECG shows coved Type 1 ST segment
elevation in keeping with a diagnosis of Brugada syndrome.