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ST segment depression and T-wave changes may be seen in patients with unstable angina; Depressed but upsloping ST segment generally rules out ischemia as a cause. Also, it can be a normal variant or artifacts, such as: Pseudo-ST-depression, which is a wandering baseline due to poor skin contact of the electrode [3]
Since PR and PT interval are regarded as baseline, ST segment elevation is regarded as a sign of myocardial ischemia. The opposing leads (such as V3 and V4 versus posterior leads V7–V9) always show reciprocal ST segment changes (ST elevation in one lead is followed by ST depression in the opposing lead).
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%. [1] ST depression may be associated with subendocardial myocardial infarction, hypokalemia, or digitalis toxicity. [2]
at least one lead of V1-V3 with concordant ST depression (Sgarbossa criterion 2) or; proportionally excessively discordant ST elevation in V1-V4, as defined by an ST/S ratio of equal to or more than 0.20 and at least 2 mm of STE. (this replaces Sgarbossa criterion 3 which uses an absolute of 5mm)
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 ...
those with ST segment elevation or new bundle branch block (suspicious for acute injury and a possible candidate for acute reperfusion therapy with thrombolytics or primary PCI), those with ST segment depression or T wave inversion (suspicious for ischemia), and; those with a so-called non-diagnostic or normal ECG.
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ST segments remains neutral in this syndrome. Those who were treated without angiography will develop anterior wall myocardial infarction in a mean period of 9 days. [4] An episode of chest pain in Wellens' syndrome is associated with ST elevation or depression and later progressed to T wave abnormality after chest pain subsided.