ST elevation

Schematic representation of normal ECG, with ST segment in purple. J point is the point where red and purple segments overlap
12-lead electrocardiogram showing ST-segment elevation (orange) in I, aVL and V1-V5 with reciprocal changes (blue) in the inferior leads, indicative of an anterior wall myocardial infarction.
An example of mildly elevated ST segments in V1 to V3 that are concave down

ST elevations refers to a finding on an electrocardiogram wherein the trace in the ST segment is abnormally high above the baseline.

Measurement

An ST elevation is considered significant if the vertical distance inside the ECG trace and the baseline at a point 0.24 seconds after the J-point is at least 0.1 mV (usually representing 1 mm or 1 small square) in a limb lead or 0.2 mV (2 mm or 2 small squares) in a precordial lead.[1] The baseline is either the PR interval or the TP interval.[2] This measure has a false positive rate of 15-20% (which is slightly higher in women than men) and a false negative rate of 20-30%.[3]

Physiology

The ST segment corresponds to a period of ventricular contraction. Because of the complete depolarization of the ventricles, represented by the QRS complex, in theory there is no net movement of charge during the ST segment. Under physiological conditions the ST segment is isoelectric (i.e. same charge across the myocardium).

Transmural ischemia

During transmural (subepicardial) ischemia the injured cells are "relatively" closer to the epicardial surface. In the case of depolarization, healthier cells will typically displace a larger amplitude and duration of depolarization. During systole, a ventricle with subepicardial ischemia will exhibit cells with higher amplitude of depolarization in the cardiac endocardium. During transmural ischemia, the Na+/K+ATPase which is responsible for the final stages of myocyte repolarization (-80mV to -90mV) is impaired, thus the ischemic cells will only be partially depolarized compared to surrounding healthy (non-ischemic) myocytes. The difference in membrane potential between healthy and ischemic cells causes negative charges to accumulate on their surfaces, generating a vector that points towards the normal cardiac cells (which have positive charges on their surface). This vector points away from the chest EKG leads, causing a downward deflection in the TP segment. However, since the TP segment is the baseline of the EKG, the machine corrects for this by raising TP to baseline which results in ST elevation. Also see ST depression.

Benign conditions

Repolarization of the ventricle normally occurs during the T wave, however one cause of ST segment elevation is the early repolarization of the heart wall. This is referred to as [benign early repolarization].

Associated conditions

The exact topology and distribution of the affected areas depend on the underlying condition. Thus, ST elevation may be present on all or some leads of ECG.

It can be associated with:

See also

References

  1. ↑ Family Practice Notebook > ST Elevation Retrieved Nov 2010
  2. ↑ Khandpur, R.S. (2003). Handbook of biomedical instrumentation (2nd ed.). New Delhi: Tata McGraw-Hill. p. 255. ISBN 978-0-07-047355-3.
  3. ↑ Sabatine MS (2000). Pocket Medicine (이소연). Lippincott Williams & Wilkins. ISBN 0-7817-1649-7.
  4. 1 2 3 4 5 6 7 Thaler, Malcolm (2009). The only EKG book you'll ever need. Lippincott Williams & Wilkins. ISBN 978-1-60547-140-2.
  5. ↑ Tingle LE, Molina D, Calvert CW (November 2007). "Acute pericarditis". American Family Physician. 76 (10): 1509–14. PMID 18052017.
  6. ↑ Chew HC, Lim SH (November 2005). "Electrocardiographical case. ST elevation: is this an infarct? Pericarditis" (PDF). Singapore Medical Journal. 46 (11): 656–60. PMID 16228101.
  7. ↑ Victor F. Froelicher; Jonathan Myers (2006). Exercise and the heart. Elsevier Health Sciences. pp. 138–. ISBN 978-1-4160-0311-3. Retrieved 10 October 2010.
  8. ↑ Plautz CU, Perron AD, Brady WJ (July 2005). "Electrocardiographic ST-segment elevation in the trauma patient: acute myocardial infarction vs myocardial contusion". The American Journal of Emergency Medicine. 23 (4): 510–6. PMID 16032622. doi:10.1016/j.ajem.2004.03.014.
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