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An ST elevation is considered significant if the vertical distance inside the ECG trace and the baseline at a point 0.04 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. [2]
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]
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 ...
J-point and horizontal or descending / downsloping ST segment (especially in inferior leads) [10] [11] [12] Elevation of ST segment by 2 mm [10] Elevation of a J-wave by 0.2 mV or more [13] J-point distribution globally [13] QRS longer than 110 ms [13] Longer duration of J wave, more than 60 ms [14]
Pseudo-ST-depression, which is a wandering baseline due to poor skin contact of the electrode [3] Physiologic J-junctional depression with sinus tachycardia [3] Hyperventilation [3] Horizontal ST depression in V4, V5, V6 leads during a cardiac stress ECG. Other, non-ischemic, causes include: Side effect of digoxin [4] [3] Hypokalemia [4] [3 ...
Progressive symmetrical deep T wave inversion in leads V2 and V3; Slope of inverted T waves generally at 60°-90° Little or no cardiac marker elevation; Discrete or no ST segment elevation; No loss of precordial R waves.
ST elevation may indicate transmural myocardial infarction. An elevation of >1mm and longer than 80 milliseconds following the J-point . 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%.
stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1. Elevation of PR segment in aVR and depression of PR in other leads especially left heart V5, V6 leads indicates atrial injury. stage 2 -- normalization of ST and PR deviations; stage 3 -- diffuse T wave inversions (may not be present in all patients)