Discordant ST changes

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.

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ECG Library (27)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypertension 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm 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.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain 12-Lead Discordant ST changes Wide QRS ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
Following Criteria Exactly, even the Modified Sgarbossa Criteria, Can Be Deadly

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Concordant ST elevation Discordant ST changes PR segment depression Wide QRS Myocarditis Pericarditis Dr Smith's ECG Blog 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: - Abdominal pain 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ECG of the Week CC-BY-NC-SA
ECG of the Week – 5th November 2018 – Interpretation

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.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea 12-Lead Discordant ST changes Excessive discordant ST elevation Pacemaker spikes Ventricular pacemaker Dr Smith's ECG Blog CC BY-NC
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure

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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dizziness 12-Lead Absent P waves Discordant ST changes Left Axis Deviation Pacemaker spikes Wide QRS ECG of the Week CC-BY-NC-SA
ECG of the Week – 2nd April 2018 – Interpretation

This ECG is from a man in his 70s who presented following several episodes of chest pain and dizziness.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Concordant ST elevation Discordant ST changes Left Axis Deviation Normal rate Pacemaker spikes Wide QRS Ventricular pacemaker Acute Anterior MI ECG of the Week 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: - Syncope 12-Lead Serial 12-lead Discordant ST changes LBBB Dr Smith's ECG Blog CC BY-NC
A 70-something woman with syncope and a wide complex – previous 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.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Discordant ST changes Tall QRS LVH Dr Smith's ECG Blog CC BY-NC
Chest Pain and ST Elevation on the Monitor – repeat ECG in ED