ST segment depression
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Introduction
Depression of the ECG ST segment.
Etiology
- subendocardial injury (myocardial ischemia)
- may occur as reciprocal ST segment depression in conjunction with ST segment elevation in other leads
- left ventricular hypertrophy (ST-segment depression & T-wave inversion)
Laboratory
Diagnostic procedures
- electrocardiogram:
- ST segment depression
- 0.5 mm in 2 or more contiguous leads is significant
Management
- defines high cardiac risk patients
- in conjunction with chest pain treat as NSTEMI
- administer P2Y12 inhibitor & heparin in high risk patients
- LMW heparin if normal kidney function, otherwise unfractionated heparin[3]
- patient should have received aspirin
- nitrates as needed for angina pectoris
- add beta-blocker as tolerated
- admit to hospital
- assess TIMI score
- urgent percutaneous coronary intervention in high-risk patients[2]
- even in the absence of elevated cardiac troponin[2]
- not indicated within 6 hours in the absence of ST segment elevation or LBBB[2]
- delayed percutaneous coronary intervention (within 72 hours) in intermediate-risk patients[2]
- cardiac stress testing in low-risk patients[2]
- urgent percutaneous coronary intervention in high-risk patients[2]
- administer P2Y12 inhibitor & heparin in high risk patients
More general terms
Additional terms
References
- ↑ ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ 3.0 3.1 NEJM Knowledge+