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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.
It is diagnosed based on an elevated J-point / ST elevation with an end-QRS notch or end-QRS slur and where the ST segment concave up. It is believed to be a normal variant. [2] Benign early repolarization that occurs as some patterns is associated with ventricular fibrillation. The association, revealed by research performed in the late 2000s ...
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 ...
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]
Early repolarization is a phenomenon that can be seen in ECG recordings of ventricular cells where there is an elevated ST segment, also known as a J wave. The J wave is prominent when there is a larger outward current in the epicardium compared to the endocardium. [19]
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Diagnosis is based on an ECG showing ST-segment depression at the J-point of 1 to 3 mm in leads V1 to V6, with tall and symmetrical T waves. [1] The ST-segment is upsloping and there is also often ST-segment elevation of 0.5 to 2 mm in lead aVR. [1] [2] The QRS complex is either normal or slightly wide. [1]