ST SEGMENT

Adityo Wibhisono

ST segment yang normal flat,

segaris isoelectric
pada EKG
antara gelombang S (the J point)
dan awal gelombang T.
Hal ini menunjukkan antara
ventricular depolarization and
repolarization.
Penyebab paling penting dari
kelainan ST segment (elevasi
atau
depressi)
adalah
myocardial
ischaemia
atau
infarction

Penyebab Dari ST Segment Deperessi

Mycoradial Iscahemic /
NSTEMI
Perubahan Reciprocal
STEMI
Posterior MI
Efek Digoxin
Supraventricular
tachycardia
Right Ventricular
hyperthrophy
Left Bundle Branch Block
Left Ventricular
Hypethrophy

Morphology of ST Depression

ST depressi dapat berupa upsloping,

downsloping, atau horizontal.
Horizontal atau downsloping ST
depressi 0.5 mm pada J-point dan
2 leadsindikasi myocardial ischaemia
Upsloping ST depressi pada lead
precordial dengan prominent De
Winters pada gelombang T highly
specific untuk occlusion of the Left
ST depression: upsloping (A), downsloping (B), horizontal
Anterior Descending.
Perubahan
Reciprocal
dari
morphologi ST elevasi dan akan
terlihat pada lead yang berlawanan
dari posisi infarct.
Posterior
MImanifestasi
pada
horizontal ST depressi pada V1-3

Patterns of ST Depression
Myocardial ischaemic

Left Main Coronary Artery Occlusion

ST
depression
due
to
subendocardial ischaemia
may
be present in a variable number
of leads and with variable
morphology. It is often most
prominent in the left precordial
leads V4-6 plus leads I, II and
aVL. Widespread ST depression
with ST elevation in aVR is seen
in
left main coronary artery occlusi
on
and severe triple vessel disease.

Patterns of ST Depression
Reciprocal Change
ST elevation during acute STEMI is associated with simultaneous ST depression in the
electrically opposite leads:
Inferior STEMI produces reciprocal ST depression in aVL ( lead I).
Lateral or anterolateral STEMIproduces reciprocal ST depression in III and aVF ( lead II).
Reciprocal ST depression in V1-3 occurs with posterior infarction .

Reciprocal ST depression in aVL with inferior STEMI

Patterns of ST Depression
Reciprocal Change

Reciprocal ST depression in III and aVF with high lateral STEMI

Patterns of ST Depression
Posterior Myocardial
Infarction

Acute posterior STEMI causes ST depression in the anterior leads V1-3, along with
dominant R waves (Q-wave equivalent) and upright T waves. There is ST
elevation in the posterior leads V7-9.

Posterior MI

Patterns of ST Depression
De Winters T Wave
This pattern of upsloping ST depression with symmetrically peaked T waves in the
precordial leads is considered to be a STEMI equivalent, and is highly specific for
an acute occlusion of the LAD.

De Winters T Waves

Patterns of ST Depression
Digoxin Effect
Digoxin effect refers to the presence on the ECG of:
Downsloping ST depression with a characteristic sagging morphology,
reminiscent of Salvador Dalis moustach
Flattened, inverted, or biphasic T waves.
Shortened QT interval.

Sagging ST segments are most evident in the lateral leads

V4-6, I and aVL.

Patterns of ST Depression
Hypokalaemia
Hypokalaemia causes widespread downsloping ST depression with T-wave
flattening/inversion, prominent T waves and a prolonged QT interval.

Hypokalaemia

Patterns of ST Depression
Right Ventricular
Hyperthrophy

RVH causes ST depression and T-wave inversion in the right precordial leads V1-3.

Right ventricular hypertrophy

Patterns of ST Depression
Right Bundle Branch Block
RBBB may produce a similar pattern of repolarisation abnormalities to RVH, with
ST depression and T wave inversion in V1-3.

Right bundle branch block

Patterns of ST Depression
Supraventricular tachycardia
Supraventricular tachycardia (e.g. AVNRT) typically causes widespread horizontal
ST depression, most prominent in the left precordial leads (V4-6). This rate-related
ST depression does not necessarily indicate the presence of myocardial
ischaemia, provided that it resolves with treatment

AV-nodal re-entry tachycardia

Ventrikel Flutter

Ventrikel Fibrilation

Ventrikel Takikardi

Supraventrikular
Takikardia

Thank You
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