Discordant ST changes
- Dr Smith's ECG Blog (2019) - Elderly with Paced Rhythm Possible Ischemic symptoms and an Equivocal Smith Modified Sgarbossa ECG, (Accessed: 24/08/2019)
Groups of Signs
Variations: ST segment
- Normal ST segment
- Tombstone ST elevation
- Downsloping ST depression
- Upsloping ST depression
- Straightened ST segment
- Flat ST segment
- Saddleback ST elevation
- Horizontal ST depression
- Widespread ST elevation
- Inferior ST elevation
- Anterior ST elevation
- Lateral ST elevation
- Anterior ST depression
- Widespread ST depression
- ST elevation in aVR
- ST elevation in posterior leads V7-9
- ST elevation in V4R
- Inferior ST depression
- Septal ST elevation
- Lateral ST depression
- Reciprocal ST depression
- ST elevation in aVL
- Coved ST elevation
- Concordant ST elevation
- Discordant ST changes
- ST elevation in III>II
- ST elevation in V1
- ST elevation in a PVC
- Excessive discordant ST elevation
- Concordant ST depression in V1-V3
- Pseudonormalised ST segment
- Excessive discordant ST depression.
- Shark fin ST elevation
This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.
This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.
This ECG is from a man in his 70s who presented with epigastric pain.
This ECG shows LBBB with discordant ST changes that do not quite meet Modified-Sgarbossa criteria. A repeat ECG showed evolution to excessive discordance. The patient went into VF shortly after and died.
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 a man in his 70s who presented with epigastric pain on a background of hypertension.
This ECG shows LBBB and occasional PVCs with discordant changes that do not meet Sgarbossa criteria. The patient self-discharged against advice before an echo could be completed for possible LVH.
This ECG is from a middle-aged male who presented with paroxysmal nocturnal dyspnoea and hypoxia on a background of heart failure, biventricular pacemaker, ICD and previous LV thrombus.
This ECG shows biventricular paced rhythm with RBBB-like morphology and discordant ST elevation in I, aVL, V3-5 due to acutely decompensated heart failure.
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.
This ECG is from a woman in her 70s who presented after a syncopal episode on a background of coronary artery disease. This was her baseline ECG for comparison.
This ECG shows LBBB with appropriate discordant ST changes.
Where did they come from?
These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.
Why are they here?
This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.
How can I use these ECGs?
You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.