Exam
ST Elevation
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ST Elevation
, ST-Segment Elevation
Measurement
Measure at 0.04 sec (1 mm) after the
J-Point
Compare to baseline (line drawn from P start to T end)
Causes
Acute
Myocardial Infarction
SEE EKG changes in acute MI
Pericarditis
Diffuse ST Elevation
Left Bundle Branch Block
Findings
Left Bundle Branch Block
in lead V1
QRS Duration
> 120 ms
QRS Complex
negative (down) in V1
Left ventricular activation delay
Hides ST segment elevation
Evaluate new
LBBB
as
Acute Coronary Syndrome
Pacemaker
with paced beats from right ventricle
Left Bundle Branch Block
in V1 with pacer spike
Not possible to diagnose Acute MI
Left Ventricular Hypertrophy
Increased
QRS Complex
amplitude
ST segment elevation/depression in precordial leads
T Wave
direction opposite to
QRS Complex
Not possible to diagnose Acute MI
Early Repolarization
More common in black men, young and athletes
Concave upwards (smiley) elevation
Other causes
Prinzmetal's Angina
Hyperkalemia
Neurologic catastrophe (e.g.
Subarachnoid Hemorrhage
)
References
Wang (2003) N Engl J Med 349:2128-35 [PubMed]
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