ST Segment and Abnormalities

Question 1

DDX of ST segment elevation

Answer 1

STEMI

Benign early repolarization

pericarditis

vasospasm

pulmonary embolism

LV aneurysm

LV hypertrophy

LBBB

Question 2

ST elevation

__ mm ST-E in __ contiguous leads except __ where __ mm ST-E is required

Answer 2

1 mm ST-E in 2 contiguous leads except V₂-V₃ where 2 mm ST-E is required

Question 3

Three types of ST-depression

Answer 3

Downsloping, horizontal, upsloping

Question 4

ST-Depression

Answer 4

0.5 mm ST-D in two contiguous leads

(same for all leads)

Question 5

Horizontal ST-depression is most concerning for ___

Answer 5

ischemia

Question 6

___ ST-depression is most concerning for ischemia

Answer 6

Horizontal

Question 7

Upsloping ST-D with peaked T-waves in ___ is concerning for proximal LAD occlusion

Answer 7

V₁ - V₃

LAD occlusion

Question 8

DDX of ST-Depression

Answer 8

NSTEMI

Posterior MI

LBBB

LVH w/ strain

Reciprocal changes

Digoxin toxicity

Question 9

What extra wave is in this ECG and what is it most commonly associated with?

Answer 9

J-wave:

Benign early repolarization

Hypothermia

Hypercalcemia

Brugada syndrome

NOTE: J-wave can help distinguish benign early repolarization vs STEMI