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An upsloping, convex ST segment is highly predictive of a myocardial infarction (Pardee sign) while a concave ST elevation is less suggestive and can be found in other non-ischaemic causes. [1] Following infarction, ventricular aneurysm can develop, which leads to persistent ST elevation, loss of S wave, and T wave inversion.
Illustration of ST segment elevation and depression The normal ST segment has a slight upward concavity. Flat, downsloping, or depressed ST segments may indicate coronary ischemia. ST elevation may indicate transmural myocardial infarction. An elevation of >1mm and longer than 80 milliseconds following the J-point.
The 2018 European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Health Federation Universal Definition of Myocardial Infarction for the ECG diagnosis of the ST segment elevation type of acute myocardial infarction require new ST elevation at J point of at least 1mm (0.1 mV) in two contiguous leads with the cut-points: ≥1 mm in all leads ...
ST elevation ≥1 mm in a lead with a positive QRS complex (i.e.: concordance) - 5 points; concordant ST depression ≥1 mm in lead V1, V2, or V3 - 3 points; ST elevation ≥5 mm in a lead with a negative (discordant) QRS complex - 2 points; ≥3 points = 90% specificity of STEMI (sensitivity of 36%) [2]
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Rule 2: The ST segment (J point) starts on the isoelectric line (except in V1 & V2 where it may be elevated by not greater than 1 mm). Rule 3: The PR interval should be 0.12–0.2 seconds long. Rule 4: The QRS complex should not exceed 0.11–0.12 seconds.
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The TIMI risk score can identify high risk patients in ST-elevation and non-ST segment elevation MI ACS [30] [31] and has been independently validated. [32] [33] Based on a global registry of 102,341 patients, the GRACE risk scoreestimates in-hospital, 6 months, 1 year, and 3-year mortality risk after a heart attack. [34]