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ST Morphology: Difference between revisions
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[[Image:normal_ST_elevation.png|thumb|Examples of normal ST elevation]] | [[Image:normal_ST_elevation.png|thumb|Examples of normal ST elevation]] | ||
[[Image:pathologic_ST_elevation.png|thumb|Examples of pathologic ST elevation. [[LVH]], [[LBBB]], [[Pericarditis]], [[Hyperkalemia]], [[Anterior AMI]] ]] | [[Image:pathologic_ST_elevation.png|thumb|Examples of pathologic ST elevation. [[LVH]], [[LBBB]], [[Pericarditis]], [[Hyperkalemia]], [[Anterior AMI]] ]] | ||
[[Image:early_repol.png|thumb|Characteristics of early repolarization]] | |||
The most important cause of '''ST elevation''' is '''acute [[Ischemia]]'''. Other causes are <cite>Wang</cite><cite>Werf</cite>: | The most important cause of '''ST elevation''' is '''acute [[Ischemia]]'''. Other causes are <cite>Wang</cite><cite>Werf</cite>: | ||
*Early repolarization | |||
*[[Clinical Disorders#Pericarditis|Acute pericarditis]]: ST elevation in all leads except aVR | *[[Clinical Disorders#Pericarditis|Acute pericarditis]]: ST elevation in all leads except aVR | ||
*[[Pulmonary_Embolism|Pulmonary embolism]]: ST elevation in V1 and aVR | *[[Pulmonary_Embolism|Pulmonary embolism]]: ST elevation in V1 and aVR | ||
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*[[Chamber_Hypertrophy_and_Enlargment|Left ventricular hypertrophy]] | *[[Chamber_Hypertrophy_and_Enlargment|Left ventricular hypertrophy]] | ||
*[[Idioventricular Rhythm|Idioventricular rhythm]] including [[Pacemaker|Paced rhythm]] | *[[Idioventricular Rhythm|Idioventricular rhythm]] including [[Pacemaker|Paced rhythm]] | ||
In a study by Otto et al. among 123 patients with chest paint and ST elevation of > 1 mm 63 patients did not have a myocardial infarction. Diagnoses in patients who did not have a myocardial infarction were [[LVH]] (33%) and [[LBBB]] (21%). <cite>Otto</cite> In daily practice this means that in these patients the diagnosis of myocardial infarction has to depend on other diagnostic means, such as laboratory tests, echocardiography and coronary angiography. | |||
An important clue for the diagnosis of ischemia is the presence of [[Ischemia|reciprocal ST depression]]. | |||
'''Early repolarization''' is a term used for ST elevation without underlying disease. It probably has nothing to do with actual early repolarization. It is commonly seen in young men. It is important to discern early repolariztion from ST elevation from other causes such as [[ischemia]]. Characteristics of early repolarization are:<cite>Kambara</cite> | |||
*concave elevation of the ST segment with a clear J wave | |||
*vertraagd einde van de R golf of een duidelijke J golf of beide | |||
*snelle QRS progressie in de voorwandsafleidingen met counterclockwise draaiing | |||
*symmetrische grote T golven | |||
*diffuse ST elevatie (niet in 1 stroomgebied, geen reciproke depressies) | |||
*persisteren van deze afwijkingen over de jaren | |||
{{clr}} | {{clr}} | ||