St Segment Depressi

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ST SEGMENTAdityo Wibhisono

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•ST segment yang normal fat,

segaris  isoelectric pada EKGantara gelombang S (the J point)dan aal gelombang T!•"al ini men#n$#%%an antara&entric#lar depolari'ation andrepolari'ation!

•enyebab paling penting dari%elainan ST segment (ele&asiata# depressi) adalahmyocardial ischaemia ata#inarction

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enyebab *ari ST Segment *eperessi

+ycoradial scahemic -.STE+er#bahan /eciprocalSTE+osterior +Ee% *igo0in

S#pra&entric#lartachycardia/ight 1entric#larhyperthrophy2et 3#ndle 3ranch 3loc%2et 1entric#lar

"ypethrophy

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•ST depressi dapat ber#pa #psloping,donsloping, ata# hori'ontal!•"ori'ontal ata# donsloping STdepressi 4 6!7 mm pada J8point dan 49 leads indi%asi myocardial ischaemia•:psloping ST depressi pada leadprecordial dengan prominent ;*eWinter<s= pada gelombang T highly

speci>c #nt#% occl#sion o the 2etAnterior *escending!•er#bahan /eciprocal darimorphologi ST ele&asi dan a%anterlihat pada lead yang berlaanandari posisi inarct!•osterior + maniestasi padahori'ontal ST depressi pada 1?8@

+orphology o ST *epression

ST depression: upsloping (A), downslo

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atterns o ST *epression

ST depressios#bendocardial ibe present in a o leads and morphology! t prominent in th

leads 18B  pl#sa12! Widespreaith ST ele&atioinlet main coronaon and se&ere tripl

Let Main Coronar! Arter! "##lusion

+yocardial ischaemic

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ST ele&ation d#ring ac#te STE+ is associated ith sim#ltaneo#s ST depreelectrically opposite leadsC•nerior STE+ prod#ces reciprocal ST depression in a12 (D lead )!•2ateral or anterolateral STE+ prod#ces reciprocal ST depression in and a1•/eciprocal ST depression in 1?8@ occ#rs ith posterior inarction !

atterns o ST *epression/eciprocal Fhange

$e#ipro#al ST depression in a%L with inerior STEM&

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atterns o ST *epression/eciprocal Fhange

$e#ipro#al ST depression in &&& and a%' with high lateral ST

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atterns o ST *epressionosterior +yocardial

narctionAc#te posterior STE+ ca#ses ST depression in the anterior leads 1?8@, al

dominant / a&es (;8a&e eH#i&alent=) and #pright T a&es! Theele&ation in the posterior leads 1I8!

osterior M&

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atterns o ST *epression*e Winters T Wa&e

 This pattern o #psloping ST depression ith symmetrically pea%ed T a&

precordial leads is considered to be a STE+ eH#i&alent, and is highly span ac#te occl#sion o the 2A*!

e *inter+s T *aes

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atterns o ST *epression*igo0in Eect

*igo0in eect reers to the presence on the EFG oC*onsloping ST depression ith a characteristic ;sagging= morpho

reminiscent o Sal&ador *ali<s mo#stach•lattened, in&erted, or biphasic T a&es!•Shortened T inter&al!

Sagging ST seg-ents are -ost eident i%./0, & and a%L1

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atterns o ST *epression"ypo%alaemia

"ypo%alaemia ca#ses idespread donsloping ST depression ith

fattening-in&ersion, prominent T a&es and a prolonged T inter&al!

2!po3alae-ia

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atterns o ST *epression/ight 1entric#lar

"yperthrophy/1" ca#ses ST depression and T8a&e in&ersion in the right precordial lea

$ight entri#ular h!pertroph!

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atterns o ST *epression/ight 3#ndle 3ranch 3loc%

/333 may prod#ce a similar pattern o repolarisation abnormalities to /

ST depression and T a&e in&ersion in 1?8@!

$ight 4undle 4ran#h 4lo#3 

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atterns o ST *epressionS#pra&entric#lar tachycardia

S#pra&entric#lar tachycardia (e!g! A1./T) typically ca#ses idespread hST depression, most prominent in the let precordial leads (18B)! This rate

ST depression does not necessarily indicate the presence o myischaemia, pro&ided that it resol&es ith treatment

A%/nodal re/entr! ta#h!#ardia

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1entri%el ibrilation

1entri%el l#tter 1entri%el Ta%i%ardi

S#pra&entri%#lar

 Ta%i%ardia

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•Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Ese•Edhouse J, Brady WJ, Morris &. ABC o' cinica eectrocardiogra(hy) Acute myocardia in'arction*Part ++. BM

#$-#/0--1)23-*3. Re!ie4. Pu"Med PM+5) 6623- Pu"Med Centra PMC+5) PMC66##2$3. &u te7t.•Phi""s BP. Ad!anced ECG) Boards and Beyond /second edition1. Ese!ier #$$3.•8mith 8W. T9:R8 ratio "est distinguishes !entricuar aneurysm 'rom anterior myocardia in'arction. Am J E

May#-/-1)#02*;0. Pu"Med PM+5) 6%26%-2;.•8ura4ic< B, =nians T. Chou>s Eectrocardiogra(hy in Cinica Practice /3th edition1, 8aunders #$$;.

 Than% Lo#