Discordant ST changes include ST elevation or depression that is in the opposite direction to the QRS complex. This includes ST elevation with a negative QRS complex, or ST depression with a positive QRS complex.
See also: ST segment
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- Dr Smith's ECG Blog (2019) - Elderly with Paced Rhythm Possible Ischemic symptoms and an Equivocal Smith Modified Sgarbossa ECG, (Accessed: 24/08/2019)
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 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.