II. Measurement

  1. Measure at 0.04 sec (1 mm) after the J-Point
  2. Compare to baseline (line drawn from P start to T end)

III. Causes: General

  1. Acute Myocardial Infarction
    1. See Electrocardiogram in Myocardial Infarction
    2. Type A Aortic Dissection may also cause Coronary Artery dissection (esp. right Coronary Artery)
  2. Pericarditis
    1. Diffuse ST Elevation
  3. Left Bundle Branch Block
    1. Findings
      1. Left Bundle Branch Block in lead V1
      2. QRS Duration > 120 ms
      3. QRS Complex negative (down) in V1
    2. Left ventricular activation delay
      1. Hides ST Segment Elevation
      2. Evaluate new LBBB as Acute Coronary Syndrome
  4. Pacemaker with paced beats from right ventricle
    1. Left Bundle Branch Block in V1 with pacer spike
    2. Not possible to diagnose Acute MI
  5. Left Ventricular Hypertrophy
    1. Increased QRS Complex amplitude
    2. ST Segment Elevation/depression in precordial leads
    3. T Wave direction opposite to QRS Complex
    4. Not possible to diagnose Acute MI
  6. Early Repolarization
    1. More common in black men, young and athletes
    2. Concave upwards (smiley) elevation
  7. Other causes
    1. Prinzmetal's Angina
    2. Hyperkalemia
      1. See Hyperkalemia Related EKG Changes
      2. ST Depression is more common
      3. Associated with Wide QRS, Bradycardia, Peaked T Waves
    3. Neurologic catastrophe (e.g. Subarachnoid Hemorrhage)
    4. Pulmonary Embolism
    5. Wolff-Parkinson-White Syndrome (WPW Syndrome)
    6. Tricyclic Antidepressant Overdose
    7. Brugada Syndrome
    8. Global Myocardial Ischemia
    9. Left Ventricular aneurysm
      1. LV Aneurysm is a complication following Myocardial Infarction
      2. Diffuse ST Elevation without reciprocal changes

IV. Causes: Diffuse ST Elevation

V. References

  1. DeMeester and Swaminathan in Swadron (2022) EM:Rap 22(8): 9-10
  2. Mattu (2022) Crit Dec Emerg Med 36(8): 13
  3. Wang (2003) N Engl J Med 349:2128-35 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies

Ontology: ST segment elevation (finding) (C0520886)

Definition (NCI_FDA) Evaluation of the interval from the end of ventricular depolarization to the onset of the T wave; it is usually isoelectric in normal subjects.
Definition (NCI) An electrocardiographic finding of ST segment elevation above the baseline.
Definition (NCI_CDISC) An electrocardiographic finding of ST segment elevation above the baseline. (NCI)
Concepts Finding (T033)
SnomedCT 142094006, 76388001, 164931005
English ST ELEVATED, ST Segment Elevation, ECG ST segment elevated, ST segment elevation (finding), Electrocardiogram ST segment elevation, ST segment elevated, ST elevated, electrocardiogram: ST segment elevated (procedure), electrocardiogram: ST segment elevated, elevated st segment, st elevation, ecg st elevation, elevated st, st elevated, st segment elevated, elevation st, ekg st elevation, elevations st, st elevation ekg, st segment elevation, ST Elevation, ST elevation (finding), S-T segment elevated, ST ELEVATION, ELEVATION, ST SEGMENT, ST Segment Elevation by EKG Finding, ST Segment Elevation by ECG Finding, ST SEGMENT ELEVATION, ST elevation, ST segment elevation, ST elevation (observable entity)
Italian Sopraslivellamento del segmento ST dell'elettrocardiogramma, Sopraslivellamento del tratto ST, Tratto ST sopraslivellato, ST sopraslivellato
Dutch ST-segment stijging, ST-segment gestegen, ST gestegen, elektrocardiogram ST-segment optrekking
French Segment ST sus-décalé, Elévation du segment ST, ST sus-décalé, SUS-DECALAGE DE ST, Segment ST sus-décalé à l'électrocardiogramme
German ST-Strecke angehoben, ST-Streckenhebung, ST angehoben, ST STRECKENERHOEHUNG, Elektrokardiogramm ST-Streckenhebung
Portuguese ST elevado, Elevação do segmento ST, Segmento ST elevado, ELEVACAO DO ST, Segmento ST elevado (ECG)
Spanish Elevación del segmento ST, ST elevado, Segmento ST elevado, ST, ELEVACION, sobreelevación del segmento ST, supradesnivel del ST (hallazgo), supradesnivel del ST, supradesnivel del intervalo S-T (entidad observable), supradesnivel del intervalo S-T, Elevación del segmento ST en el electrocardiograma
Japanese 心電図ST部分上昇, ST上昇, ST部分上昇, STジョウショウ, STブブンジョウショウ, シンデンズSTブブンジョウショウ
Czech Elevace úseku ST na elektrokardiogramu, Elevace úseku ST, Zvýšený úsek ST, Zvýšený ST
Hungarian Elektrokardiogram ST szakasz emelkedés, ST szakasz emelkedett, ST szakasz emelkedés, ST emelkedett