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ST segment | Case-based insights: ECG

4 Cases

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The ST segment

In the healthy heart, once excitation propagation is complete, there is a uniform state of excitation throughout the ventricular myocardium so that the ST segment is on the isoelectric line. ST segment depression or elevation may occur with myocardial dysfunction. ST segment depression occurs in (inner-layer) ischemia, non-ST elevation myocardial infarction (NSTEMI), hypertensive heart disease with left-ventricular hypertrophy, LBB, pulmonary embolism, tachycardia, cerebral hemorrhage, and on digitalis medication, among others. ST elevations occur in STEMI, cardiac wall aneurysm, and pericarditis, but also after cardioversion (“cardiac memory”) and less commonly in takotsubo syndrome, pulmonary embolism (III, aVR, V1), and cerebral hemorrhage. In main trunk occlusion (or high-grade main trunk stenosis), ST elevation may be limited to the aVR and V1 leads, with concomitant ST depression in most other leads. These elevations can be easily overlooked because aVR and V1 are usually not considered for ischemia diagnosis.

This content was originally published in German and has been translated to English.

Image Credits
Area: Bradycardia - teaser image/© Eva Künzel, Area: bundle branch block - teaser image/© Eva Künzel, Area: P-wave - teaser image/© Eva Künzel, Area: Pacemaker - teaser image/© Eva Künzel, Area: QRS complex - teaser image/© Eva Künzel, Area: Special cases - teaser image/© Eva Künzel, Area: T-wave - teaser image/© Eva Künzel, Area: Tachycardia - teaser image/© Eva Künzel