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ECG Findings

  • ST segment depression ≥ 1 mm in consecutive leads.

  • ST segments may be horizontal or downsloping.

Pearls

  1. Some ST depression in the lateral precordial leads (V4-V6) is common at higher heart rates and is commonly seen during exercise treadmill tests, but such depression should not be downsloping unless ischemia is also present.

  2. ST elevation in other leads suggests that the depression may represent reciprocal changes from acute injury rather than subendocardial ischemia.

  3. Downsloping ST depression may also be seen in left ventricular hypertrophy (LVH), but this depression should not be dynamic and should be stable with serial ECGs. ST depression from ischemia will be dynamic, changing with time on serial ECGs.

  4. Isolated ST depression in leads V1 and V2 may represent posterior ischemia.

FIGURE 23.8A

Subendocardial Ischemia. (ECG contributor: James V. Ritchie, MD.)

FIGURE 23.8B

Downsloping ST segments depressed greater than 1 mm (arrow). These changes were dynamic over time. The patient sustained a nontransmural myocardial infarction.

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