Concordant ST elevation occurs when there is ST elevation with a positive wide QRS complex, e.g. bundle branch blocks, ventricular rhythms or ventricular pacemakers. It is considered to be concordant because the ST segment moves in the same direction as the QRS. This sign is abnormal and can suggest coronary occlusion.
See also: ST segment
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This ECG is from a woman in her 40s who presented with chest pain that had been waxing and waning over the past 24 hours. She had a history of renal failure on dialysis, hypertension, diabetes and a normal catheterisation a year ago. This was her initial ECG.
This ECG shows sinus tachycardia with nonspecific intraventricular delay, tall QRS and widespread PR segment depression. The ST segments are all discordant apart from V4 and V1. These changes were dynamic over serial ECGs. The cath was again normal. Echo showed a trace of pericardial effusion. The diagnosis was myopericarditis.
This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his first prehospital ECG.
This ECG shows ventricular paced rhythm with concordant STE in aVR and concordant ST depression in II, III, aVF. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.
This ECG is from an elderly male who presented with chest pain. He has a pacemaker. This was his second prehospital ECG.
This ECG shows ventricular paced rhythm with excessive discordant ST elevation in V3 as well as concordant ST elevation in V2 and V4. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.
This ECG is from a woman in her 80s who presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This repeat ECG was recorded 60 min after presentation when she had further chest pain.
This ECG shows ventricular pacing with concordant ST elevation in I and V6, and excessive discordant ST elevation in V2-4. The cause was an acute anterior MI.
This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded after atropine.
This ECG shows sinus rhythm with second degree type 1 AV block and LBBB. Concordant ST elevation in III and aVF and concordant ST depression in V2. The cause was an occluded proximal right coronary artery. This was missed and the patient died.