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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]
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. [1]
Schematic representation of normal ECG. In electrocardiography, the ST segment connects the QRS complex and the T wave and has a duration of 0.005 to 0.150 sec (5 to 150 ms). It starts at the J point (junction between the QRS complex and ST segment) and ends at the beginning of the T wave.
There are several methods to determining the ECG axis. The easiest method is the quadrant method, where one looks at lead I and lead aVF. First, examine the QRS complex in both leads I and avF and determine if the QRS complex is positive (height of R wave > S wave), equiphasic (R wave = S wave), or negative (R wave < S wave).
Electrocardiography is the process of producing an electrocardiogram (ECG or EKG [a]), a recording of the heart's electrical activity through repeated cardiac cycles. [4] It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the heart [5] using electrodes placed on the skin.
ECG would be abnormal in 75 to 95% of the patients. Characteristic ECG changes would be large QRS complex associated with giant T wave inversion [4] in lateral leads I, aVL, V5, and V6, together with ST segment depression in left ventricular thickening. For right ventricular thickening, T waves are inverted from V2 to V3 leads.
Acute coronary syndrome is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels): [4] ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina. [5]
those with ST segment depression or T wave inversion (suspicious for ischemia), and; those with a so-called non-diagnostic or normal ECG. A normal ECG does not rule out acute myocardial infarction. Mistakes in interpretation are relatively common, and the failure to identify high risk features has a negative effect on the quality of patient ...