Concordant ST elevation

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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In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation 12-Lead Dr Smith's ECG Blog CC BY-NC
A 70-something with Ventricular Paced Rhythm and Chest Pain

This ECG is from a patient in their 70s who presented with intermittent chest pain for a couple of days that became constant shortly before they presented.

This ECG shows ventricular paced rhythm with concordant ST elevation in V5. The cause was a mid-LAD occlusion of a wraparound LAD.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Discordant ST changes PR segment depression Wide QRS Myocarditis Pericarditis 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
A patient with chest pain and dynamic ST elevation

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Inferior ST depression Wide QRS Ventricular pacemaker Limb leads Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Concordant ST elevation Excessive discordant ST elevation Wide QRS Ventricular pacemaker Acute Anterior MI Chest leads Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Anterior MI in paced rhythm, dismissed by cardiologist, 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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Standard Calibration Concordant ST elevation Normal Sinus Rhythm LBBB Acute Inferior MI Acute Lateral MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
Is there Wellens’ syndrome in left bundle branch block? Or in inferior and lateral leads?

This ECG is from a man in his 80s who presented with acute chest pain.

This ECG shows LBBB with concordant STE in II, V5 and V6 due to inferior and lateral MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Left Axis Deviation Normal rate Anterior ST elevation Concordant ST elevation Excessive discordant ST elevation Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI 12-Lead Serial 12-lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 25th December 2017 – 60 min later

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Left Axis Deviation Normal rate Concordant ST elevation Discordant ST changes Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 25th December 2017 – Interpretation

This ECG is from a woman in her 80s presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This was the initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Fatigue Normal Axis Concordant ST depression in V1-V3 Concordant ST elevation LBBB Second degree AV block type 1 - Wenckebach Acute Inferior MI Acute Posterior MI 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
See what happens when one fails to diagnose STEMI in LBBB and Paced Rhythm

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.

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